Inappropriate prescription of low molecular weight heparins for thromboprophylaxis among older hospitalized patients

Sabrina Garasto, Sergio Fusco, Graziano Onder, Federica Sganga, Federica Mammarella, Stefano Volpato, Carmelinda Ruggiero, Angela M Abbatecola, Fabrizia Lattanzio, Andrea Corsonello

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Abstract

AIM: To investigate the prevalence and clinical correlates of overprescribing and underprescribing of low molecular weight heparins (LMWHs) for thromboprophylaxis among older medical inpatients.

METHODS: Eight hundred seventy six patients (mean age 81.5 ± 7.6 years, female gender 57.2 %) enrolled in a multicenter observational study of seven acute care wards of geriatric medicine in Italy. The risk of venous thromboembolism was ascertained by calculating the Padua score for each patient. Patients receiving appropriate prescription of LMHW during stay were compared to those receiving LMHW with a Padua score <4 (overprescribing group). Similarly, patients with a high thromboembolic risk (Padua score ≥4) but not receiving LMHW (underprescribing group) were compared to patients appropriately not receiving LMHW during stay. Independent correlates of overprescribing and underprescribing were investigated by logistic regression analysis.

RESULTS: Overall, 42.8 % of patients had a Padua score ≥4. LMWHs were overprescribed in 7.3 % and underprescribed in 25.2 % of patients. The number of lost basic activities of daily living (BADL) (OR = 0.25; 95 % CI 0.15-0.41) and the number of diagnoses (OR = 0.76; 95 % CI 0.61-0.95) were inversely associated with LMWH overprescription. Conversely, older age (75-84 years: OR = 2.39; 95 % CI 1.10-5.19-85 years or more: OR = 3.25, 95 % CI 1.40-7.61), anemia (OR = 1.80, 95 % CI 1.05-3.16), pressure sores (OR = 4.15, 95 % CI 1.20-14.3), number of lost BADL at the admission (OR = 3.92, 95 % CI 2.86-5.37) and number of diagnoses (OR = 1.29, 95 % CI 1.15-1.44) qualified as significant correlates of LMWH underprescription.

DISCUSSION: Underprescription and, to a lesser extent, overprescription still represent an issue among older medical inpatients.

CONCLUSION: Implementing risk-stratifying scores into clinical practice may improve appropriateness of LMWHs prescribing during hospitalization.

Original languageEnglish
Pages (from-to)483-490
Number of pages8
JournalAging clinical and experimental research
Volume29
Issue number3
DOIs
Publication statusPublished - Jun 2017

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Inappropriate Prescribing
Low Molecular Weight Heparin
Activities of Daily Living
Inpatients
Pressure Ulcer
Venous Thromboembolism
Geriatrics
Italy
Multicenter Studies
Observational Studies
Prescriptions
Anemia
Hospitalization
Logistic Models
Regression Analysis
Medicine

Keywords

  • Journal Article

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Inappropriate prescription of low molecular weight heparins for thromboprophylaxis among older hospitalized patients. / Garasto, Sabrina; Fusco, Sergio; Onder, Graziano; Sganga, Federica; Mammarella, Federica; Volpato, Stefano; Ruggiero, Carmelinda; Abbatecola, Angela M; Lattanzio, Fabrizia; Corsonello, Andrea.

In: Aging clinical and experimental research, Vol. 29, No. 3, 06.2017, p. 483-490.

Research output: Contribution to journalArticle

Garasto, Sabrina ; Fusco, Sergio ; Onder, Graziano ; Sganga, Federica ; Mammarella, Federica ; Volpato, Stefano ; Ruggiero, Carmelinda ; Abbatecola, Angela M ; Lattanzio, Fabrizia ; Corsonello, Andrea. / Inappropriate prescription of low molecular weight heparins for thromboprophylaxis among older hospitalized patients. In: Aging clinical and experimental research. 2017 ; Vol. 29, No. 3. pp. 483-490.
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AU - Garasto, Sabrina

AU - Fusco, Sergio

AU - Onder, Graziano

AU - Sganga, Federica

AU - Mammarella, Federica

AU - Volpato, Stefano

AU - Ruggiero, Carmelinda

AU - Abbatecola, Angela M

AU - Lattanzio, Fabrizia

AU - Corsonello, Andrea

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N2 - AIM: To investigate the prevalence and clinical correlates of overprescribing and underprescribing of low molecular weight heparins (LMWHs) for thromboprophylaxis among older medical inpatients.METHODS: Eight hundred seventy six patients (mean age 81.5 ± 7.6 years, female gender 57.2 %) enrolled in a multicenter observational study of seven acute care wards of geriatric medicine in Italy. The risk of venous thromboembolism was ascertained by calculating the Padua score for each patient. Patients receiving appropriate prescription of LMHW during stay were compared to those receiving LMHW with a Padua score <4 (overprescribing group). Similarly, patients with a high thromboembolic risk (Padua score ≥4) but not receiving LMHW (underprescribing group) were compared to patients appropriately not receiving LMHW during stay. Independent correlates of overprescribing and underprescribing were investigated by logistic regression analysis.RESULTS: Overall, 42.8 % of patients had a Padua score ≥4. LMWHs were overprescribed in 7.3 % and underprescribed in 25.2 % of patients. The number of lost basic activities of daily living (BADL) (OR = 0.25; 95 % CI 0.15-0.41) and the number of diagnoses (OR = 0.76; 95 % CI 0.61-0.95) were inversely associated with LMWH overprescription. Conversely, older age (75-84 years: OR = 2.39; 95 % CI 1.10-5.19-85 years or more: OR = 3.25, 95 % CI 1.40-7.61), anemia (OR = 1.80, 95 % CI 1.05-3.16), pressure sores (OR = 4.15, 95 % CI 1.20-14.3), number of lost BADL at the admission (OR = 3.92, 95 % CI 2.86-5.37) and number of diagnoses (OR = 1.29, 95 % CI 1.15-1.44) qualified as significant correlates of LMWH underprescription.DISCUSSION: Underprescription and, to a lesser extent, overprescription still represent an issue among older medical inpatients.CONCLUSION: Implementing risk-stratifying scores into clinical practice may improve appropriateness of LMWHs prescribing during hospitalization.

AB - AIM: To investigate the prevalence and clinical correlates of overprescribing and underprescribing of low molecular weight heparins (LMWHs) for thromboprophylaxis among older medical inpatients.METHODS: Eight hundred seventy six patients (mean age 81.5 ± 7.6 years, female gender 57.2 %) enrolled in a multicenter observational study of seven acute care wards of geriatric medicine in Italy. The risk of venous thromboembolism was ascertained by calculating the Padua score for each patient. Patients receiving appropriate prescription of LMHW during stay were compared to those receiving LMHW with a Padua score <4 (overprescribing group). Similarly, patients with a high thromboembolic risk (Padua score ≥4) but not receiving LMHW (underprescribing group) were compared to patients appropriately not receiving LMHW during stay. Independent correlates of overprescribing and underprescribing were investigated by logistic regression analysis.RESULTS: Overall, 42.8 % of patients had a Padua score ≥4. LMWHs were overprescribed in 7.3 % and underprescribed in 25.2 % of patients. The number of lost basic activities of daily living (BADL) (OR = 0.25; 95 % CI 0.15-0.41) and the number of diagnoses (OR = 0.76; 95 % CI 0.61-0.95) were inversely associated with LMWH overprescription. Conversely, older age (75-84 years: OR = 2.39; 95 % CI 1.10-5.19-85 years or more: OR = 3.25, 95 % CI 1.40-7.61), anemia (OR = 1.80, 95 % CI 1.05-3.16), pressure sores (OR = 4.15, 95 % CI 1.20-14.3), number of lost BADL at the admission (OR = 3.92, 95 % CI 2.86-5.37) and number of diagnoses (OR = 1.29, 95 % CI 1.15-1.44) qualified as significant correlates of LMWH underprescription.DISCUSSION: Underprescription and, to a lesser extent, overprescription still represent an issue among older medical inpatients.CONCLUSION: Implementing risk-stratifying scores into clinical practice may improve appropriateness of LMWHs prescribing during hospitalization.

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