Provider perceptions of extended venous thromboembolism prophylaxis for hospitalized medically ill patients

Abstract Background Almost one-fourth of medically ill patients may remain at risk for venous thromboembolism (VTE) following hospital discharge, yet few receive extended-duration VTE prophylaxis. Methods This qualitative study at a single academic medical center assessed hospitalists’ perceptions of and barriers to implementation of extended-duration VTE prophylaxis following hospital discharge for the medically ill with the purpose of generating topics and hypotheses for future study. A focus group was conducted using semi-structured facilitator template to guide the discussion. Anonymous verbatim data transcribed from focus group participants were summarized using thematic analysis. Results Fifteen hospitalist providers at University of Utah Hospital participated in this focus group. Themes uncovered during the session included perceived low burden of post-hospitalization VTE; lack of compelling evidence supporting the net clinical benefit of extended-duration prophylaxis; concern for high medication cost; practical uncertainty about prescribing extended-duration prophylaxis; and added risk of complications (bleeding events, transitions of care confusion, polypharmacy). Conclusions This group of providers believed post-hospitalization VTE risk in the medically ill is not sufficiently high to justify potential risks of extended-duration VTE prophylaxis and that a strong case for net clinical benefit and cost-effectiveness has not been made. These qualitative data are hypothesis-generating and future research should clearly define and quantify the timing and risk of VTE following hospitalization for medical illness in a real-world population, validate practical VTE and bleeding risk stratification schema, and explore cost-effectiveness of extended-duration prophylaxis. Ultimately, providers seek a clear message of which patients derive net clinical benefit from extended-duration VTE prophylaxis.