Abstract 130: Deep Vein Thrombosis/Pulmonary Embolization in the Get With The Guidelines-Stroke Acute Ischemic Stroke Population: Incidence and Patterns of Prophylaxis
Objective. Venous thomboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolus (PE), represents a serious complication in hospitalized ischemic stroke patients. This study was undertaken to determine the incidence and patterns of prophylaxis for VTE in the GWTG-Stroke population.
Methods. From 323,363 adult ischemic stroke patients enrolled in GWTG-Stroke, patients who were not admitted, had their stroke as an inpatient, died or discharged by day 2, ambulatory by day 2, ambulatory status unknown, VTE prophylaxis contraindicated, and comfort care by day 2 were excluded leaving 149,916 patients from 1,259 sites, of whom 136,432/149,916 (91%) had information on DVT/PE occurrence. Analysis of patient variables and site characteristics were performed in relation to reported administration of VTE prophylaxis. Multivariable models were constructed based on demographics, initial NIHSS, medical history, receipt of tPA or other therapy, and hospital characteristics.
Results. The overall rate of DVT/PE was 3.01% (4,100/136,432). Excluding sites with VTE rates = 0% or >50% reduced this rate to 2.81% (3,408/121,276). The overall rate of VTE prophylaxis in the analysis cohort was 93% (139,476/149,916). Site prophylaxis rates were median 95% (25th-75th percentiles, 89%-98%) and ranged from 17% (1 site) to 100% (101 sites). Factors associated with increased likelihood of VTE prophylaxis in the multivariable model included history of atrial fibrillation/flutter (OR 1.50; 95% CI 1.42-1.59), receipt of IV (OR 1.24; 95% CI1.15-1.35) or IA tPA (OR 1.34; 95% CI 1.13-1.59), and admission to an academic hospital (OR 1.68; 95% CI 1.44-1.97). Increasing age (OR 0.95; 95% CI 0.94-0.96) and black race (OR 0.92; 95% CI 0.86-0.98), as well as history of peripheral vascular disease (OR 0.84; 95% CI 0.78-0.90), diabetes (OR 0.92; 95% CI:0.88-0.95), or prior stroke/TIA (OR 0.92; 95% CI 0.87-0.97) were associated with lower likelihood of prophylaxis. Patients receiving care in the Midwest region were less likely to receive prophylaxis compared to other regions (OR 0.73; 95% CI 0.61-0.88).
Conclusions: Despite a high overall rate of prophylaxis, DVT/PE continue to occur in approximately 3% of GWTG-Stroke patients. Reported rates of VTE prophylaxis differ among hospitals by region, and among different patients by age, race, and medical co-morbidities.
- © 2012 by American Heart Association, Inc.