Emergency department use of thromboprophylaxis in patients not requiring admission: results from the URGENTV study

Jiménez Hernández S, Martínez Fernández S, Merlo Loranca M, Fernández Núñez JM, Ruiz Romero F, García Bermejo P

Objectives: To determine the number of patients at moderate to high risk for

thromboembolism who are discharged from hospital emergency departments without

appropriate treatment to prevent thrombosis. To analyze the factors associated with not

starting thromboprophylaxis.

Methods: This multicenter, retrospective, observational, epidemiologic study included

patients who came to a hospital emergency department with an acute medical emergency

or an exacerbation of a chronic disease and who did not require admission. The dependent

variable was failure to prescribe thromboprophylaxis on discharge. Independent variables

assessed were demographic characteristics, medical specialty, general medical history,

characteristics related to the emergency department visit, and foreseen mobility at

discharge. The PRETEMED scale to quantify the need for prophylaxis was used.

Results: We assessed a total of 2280 patients; 1850 (81.1%) were at moderate to high

risk. Of these, 42.1% were discharged without thromboprophylaxis. The variables

independently associated with not starting such treatment were bed rest not foreseen on

discharge (odds ratio [OR], 19.67; 95% confidence interval [CI], 13.83-27.99; P<.0005), reduced mobility not foreseen on discharge (OR, 6.8; 95% CI, 5.2-8.9; P<.0005), history of neurodegenerative disease (OR, 1.7; 95% CI, 1.2-2.5; P=.003), emergency department stay longer than 12 hours (OR, 1.3; 95% CI, 1.1-1.8; P=.007), and advanced age (OR, 1.03; 95% CI, 1.02-1.04; P<.005). Conclusions: A large percentage of hospital emergency department patients at high to moderate risk of thromboembolism are discharged without prophylaxis.

Fernández Núñez JM, García Bermejo P, Jiménez Hernández S, Martínez Fernández S, Merlo Loranca M, Ruiz Romero F