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Prophylaxis against venous thromboembolism in hospitalized patients with severe active ulcerative colitis

May's publication of the Alimentary Pharmacology & Therapeutics examines the use of pharmacological prophylaxis against venous thromboembolism in hospitalized patients with severe active ulcerative colitis.

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Hospitalized patients with inflammatory bowel disease are 1.5- to 3.5-fold more likely to develop venous thromboembolism compared to controls.

Clinical guidelines recommend pharmacological prophylaxis.

Dr Pleet and colleagues from Massachusetts, USA determined the rate of pharmacological venous thromboembolism prophylaxis prescription and administration in a cohort of hospitalized patients with severe active ulcerative colitis.

The research team assessed predictors of failure to order pharmacological prophylaxis at 24 hours.

The researchers performed a retrospective review of hospitalized patients with severe active ulcerative colitis, admitted to a single tertiary care hospital from 2005 to 2012.

Adequate thromboembolism prophylaxis was defined as an order for low-dose unfractionated heparin 2 to 3 times daily, low-molecular weight heparin 40 mg daily or fondaparinux 2.5 mg daily ordered and administered for >80% of the admission.

Patient related factors associated with failure order prophylaxis at 24 hours were accessed as secondary outcomes.

Only 7% of patients received adequate pharmacological prophylaxis
Alimentary Pharmacology & Therapeutics

The research team found that 336 patients were hospitalized with severe active ulcerative colitis.

Hospitalists had prescribed appropriate pharmacological prophylaxis by 48 hours in only 37% of cases.

Of these, nurses administered all prescribed doses in 18% of cases.

The team observed that only 7% of patients received adequate pharmacological prophylaxis for more than 80% of their hospitalization.

Hematochezia, elevated platelets, male gender coupled with younger age, and admission on a biologic were associated with failure to order prophylaxis.

Dr Pleet's team concludes, "Hospitalized patients admitted with severe active ulcerative colitis are not receiving appropriate pharmacological venous thromboembolism prophylaxis."

Aliment Pharmacol Ther 2014: 39(9): 940–948
10 April 2014

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