Evaluation of the Management of Acute Venous Thromboembolism and Its Outcomes: One Institution's Experience.

BACKGROUND: There is often a divergence between standardized practice guidelines and actual practice. Such deviations can result in adverse outcomes. In addition, studies that identify independent risk factors associated with bleeding or recurrent venous thromboembolism (VTE) are often limited.
OBJECTIVE: We sought to evaluate the appropriateness of VTE management at our Veterans Affairs facility in Fargo and to identify independent patient characteristics or treatments that were associated with recurrence of VTE or major bleeding.
METHODS: We performed a retrospective chart review of patients admitted for deep vein thrombosis (DVT) and/or pulmonary embolism (PE).
RESULTS: Of the patients who were given enoxaparin, 96% received an appropriate dose; however, of the patients receiving unfractionated heparin, only 54.7% received an appropriate initial dose. The International Normalized Ratio (INR) was below 1.9 in 19.3% of patients when heparin was stopped, unknown in 12.7%, and 1.9 or higher in 68%. Thirty-two patients (21.3%) continued to take warfarin for three months or less, and 13 of these patients (41%) were treated for an idiopathic VTE. Forty-eight patients (57%) being treated for VTE for the first time continued with warfarin for more than six months. Twenty-one patients (14%) were started on 10 mg of warfarin daily; 40% received heparin for less than five days. The only significant difference between the bleeding and non-bleeding groups was an INR above 3 at the time of the bleeding episode (P < 0.0001).
CONCLUSION: We learned that the management of VTE at our institution diverged from standardized practice guidelines. Larger randomized, prospective studies are needed to identify independent risk factors for major bleeding or recurrence of VTE and their correlation with patient outcomes.