Thromboembolism prophylaxis in end-stage renal disease

OBJECTIVE: This study aimed to identify risk for venous thromboembolism (VTE) and prophylaxis patterns for endstage renal disease (ESRD) patients admitted through the emergency department (ED). METHODS: ESRD patients admitted through the ED in an urban teaching hospital were enrolled in this observational cohort. Admissions through the ED were reviewed as part of a VTE prophylaxis utilization analysis. Patients with moderate to high risk for VTE based on a modified risk assessment model were considered in need of prophylaxis. Prophylaxis was defined as medical (heparin/low-molecular-weight heparin) or mechanical prophylaxis. Readmissions during the following year were monitored through an electronic database for thrombosis-related International Classification of Diseases, Ninth Revision codes. RESULTS: Thirty patients met enrollment criteria. Twenty of the 30 patients (67%) were at moderate or higher risk for VTE and considered in need of VTE prophylaxis; 6 patients (30%) were actively prophylaxed. High risk was associated with a lower probability of appropriate prophylaxis (p <0.04). Three patients (10%) had a clotting-related outcome. CONCLUSIONS: The 30% rate of VTE prophylaxis in the ESRD group is consistent with the general prophylaxis rate. Lower-risk patients appropriately received no treatment, whereas treatment was omitted in high-risk ESRD patients. The observed rate of 10% thrombosis-related diagnoses may underestimate the actual thrombosis rate.