Overutilization of pharmacological venous thromboembolism prophylaxis among medical and surgical critically Ill patients: A retrospective observational cohort study

Abstract

Abstract Background Venous thromboembolism (VTE) is a major cause of morbidity among critically ill patients. While most existing evidence highlights the underuse of thromboprophylaxis, the overutilization of pharmacologic VTE prophylaxis in patients who do not meet guideline-based eligibility criteria remains underexplored, despite its potential clinical and economic consequences. Objective To evaluate the clinical outcomes and economic burden of the inappropriate overutilization of pharmacologic VTE prophylaxis among medical and surgical ICU patients. Methods A retrospective observational, single-center study included adult medical and surgical ICU patients who received pharmacological VTE prophylaxis. VTE risk was assessed using the Padua score for medical patients and the Caprini score for surgical patients. Overutilization (inappropriate thromboprophylaxis) was defined as the administration of pharmacological VTE prophylaxis to patients who did not meet guideline-based eligibility criteria. Clinical adverse events and the pharmacoeconomic burden of the inappropriate overutilization were evaluated. Results A total of 330 patients were included (271 medical and 59 surgical). Among both groups, 89.83% of surgical patients and 67.89% of medical patients were classified as high risk for VTE. Inappropriate thromboprophylaxis was observed in 28.18% of patients, more prevalent among medical than surgical patients [32.10% vs. 10.17%, ( p = 0.004)]. Patients who received prophylaxis inappropriately had significantly higher rates of bleeding [29% vs. 13.5%, ( p < 0.001)], longer ICU stays (Mean ± SD) [7.4 ± 7.1 vs 4.6 ± 5.4, ( p < 0.001)]. Inappropriate prophylaxis increased the cost of hospital stays due to bleeding (Mean EGP ± SD) [1231 ± 2016 vs 646 ± 1580, ( p = 0.004)] than those who received appropriate prophylaxis. Conclusions Overutilization of pharmacologic VTE prophylaxis among ICU patients was common, reflecting a tendency toward routine initiation of prophylaxis irrespective of risk stratification. The associated economic burden underscores the need for implementing anticoagulant stewardship programs, which could enhance patient safety and optimize resource utilization. Future multicenter studies are necessary to validate these findings. Clinicaltrial.gov Registry: NCT06539156.