VTE Prophylaxis Underused In Heart Failure Patients
CHICAGO — Deep vein thrombosis prophylaxis for hospitalized patients with heart failure is recommended in evidence-based guidelines but frequently omitted in practice.
“High medical acuity, an increased prevalence of venous thromboembolism [VTE] risk factors, and a low rate of VTE prophylaxis present a triple threat to heart failure patients,” Dr. Gregory Piazza said at the annual meeting of the American College of Cardiology.
He studied 5,451 consecutive patients with ultrasound-confirmed deep vein thrombosis (DVT) in a prospective registry that included 685 patients with a history of heart failure.
The heart failure patients were significantly more likely to have VTE risk factors, including acute infection, chronic obstructive pulmonary disease, and immobilization, and they had more comorbid medical conditions. (See box.) Moreover, 48% of the heart failure patients had been hospitalized recently prior to their VTE. Yet only 46% of heart failure patients had received any VTE prophylaxis.
There is a low rate of VTE prophylaxis in hospitalized heart failure patients, despite the published recommendations of the American College of Chest Physicians and other groups.
In heart failure patients, “the comorbid conditions that give them such high medical acuity and put them at such high risk for VTE also put them at high risk for bleeding. So there's a tendency to shy away from pharmacologic prophylaxis with anticoagulants in these patients,” said Dr. Piazza, a cardiovascular medicine fellow at Beth Israel Deaconess Medical Center, Boston. “Also, I think that because heart failure patients have so many comorbid conditions, VTE prophylaxis might fall lower on the priority list of things physicians have to take care of.”
Bringing about improvement in the situation will entail making clinicians more aware of the ACCP guidelines recommending VTE prophylaxis in hospitalized heart patients. In addition, cardiologists who consult on heart failure patients need to identify VTE prophylaxis on their list of recommendations, he continued.
In an interview, Dr. Piazza said future studies will establish whether it's safe and effective for hospitalized heart failure patients to continue on VTE prophylaxis for a while after being discharged home, as is now routine for 4–6 weeks in orthopedic surgery patients.
This issue of VTE prophylaxis in heart failure patients is not going to go away, the physician stressed.
This study was sponsored by Sanofi Aventis. Dr. Piazza disclosed he has no financial ties with the company.
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