Wang et al identified risk factors for venous thromboembolism in hospitalized patients receiving thromboprophylaxis. These can help to identify a patient who may require more aggressive management. The authors are from Washington University, Ohio State University and BJC HealthCare in Saint Louis.
Patient selection: hospitalized patient on thromboprophylaxis
Risk factors for venous thromboembolism:
(1) hospitalization for cranial surgery (odds ratio 16.1)
(2) admission to the intensive care unit (ICU, odds ratio 3.0)
(3) admission white blood cell count > 13,000 per µL (odds ratio 2.7)
(4) indwelling central venous catheter (odds ratio 2.5)
(5) admission from a long-term care facility (odds ratio 2.1
In univariate analysis a venous thromboembolism in the past year had a p value of 0.13. Other history of thromboembolism not reported. A person with significant hypercoagulable state might be on therapeutic anticoagulation and so excluded.
Interventions in a patient considered high risk:
(1) aggressive early ambulation
(2) use of enoxaparin for thromboprophylaxis rather than unfractionated heparin
(3) use of mechanical interventions
