Provider perceptions of extended venous thromboembolism prophylaxis for hospitalized medically ill patients

Abstract

Background: Almost one-fourth of medically ill patients may remain at risk for venous thromboembolism (VTE) following hospital discharge, yet few receive extended-duration VTE prophylaxis. Methods: This qualitative study at a single academic medical center assessed hospitalists’ perceptions of and barriers to implementation of extended-duration VTE prophylaxis following hospital discharge for the medically ill with the purpose of generating topics and hypotheses for future study. A focus group was conducted using semi-structured facilitator template to guide the discussion. Anonymous verbatim data transcribed from focus group participants were summarized using thematic analysis. Results: Fifteen hospitalist providers at University of Utah Hospital participated in this focus group. Themes uncovered during the session included perceived low burden of post-hospitalization VTE; lack of compelling evidence supporting the net clinical benefit of extended-duration prophylaxis; concern for high medication cost; practical uncertainty about prescribing extended-duration prophylaxis; and added risk of complications (bleeding events, transitions of care confusion, polypharmacy). Conclusions: This group of providers believed post-hospitalization VTE risk in the medically ill is not sufficiently high to justify potential risks of extended-duration VTE prophylaxis and that a strong case for net clinical benefit and cost-effectiveness has not been made. These qualitative data are hypothesis-generating and future research should clearly define and quantify the timing and risk of VTE following hospitalization for medical illness in a real-world population, validate practical VTE and bleeding risk stratification schema, and explore cost-effectiveness of extended-duration prophylaxis. Ultimately, providers seek a clear message of which patients derive net clinical benefit from extended-duration VTE prophylaxis.

Keywords

• Extended-duration
• Venous thromboembolism prophylaxis
• Medically ill
• Provider
• Perceptions