Background: The percentage of deep vein thrombosis (DVT) prophylaxis in intracerebral hemorrhage (ICH) patients remains low despite American Stroke Association guidelines. As part of a multi-hospital system wide quality initiative, we sought to determine the compliance of DVT prophylaxis in our population of ICH patients retrospectively and resulting rate of DVT/ pulmonary embolism (PE) to establish a baseline for comparison in future years to further standardization and quality of care.
Methods: Data from 25 facilities in the Providence Health System Stroke Registry were analyzed from 2010 to 2014. Patients included were those who had a principal diagnosis of ICH and documentation was present for whether DVT or PE had occurred. Patients who were placed on comfort measures at any time during hospitalization were excluded. Descriptive analysis was conducted to assess use of chemical versus mechanical venous thromboembolism (VTE) prophylaxis and whether or not patients had a documented DVT or PE.
Results: There were 1,581 ICH patients included in the analysis. Mean age at hospitalization was 67.0 (±15.5) and 55.4% were male. Of those that received VTE prophylaxis, 72 patients (4.4%) received chemical prophylaxis, including low-dose unfractionated heparin (LDUH), low-molecular-weight heparin (LMWH), factor Xa inhibitor or warfarin. Mechanical VTE prophylaxis including intermittent pneumatic compression (IPC), graduated compression stockings, or venous foot pumps were administered to 1,427 patients (87.6%). 127 patients (7.8%) had no documentation of VTE prophylaxis. Among those who received either chemical or mechanical VTE prophylaxis, 35 patients (2.5%) had documentation of a DVT or PE during the hospital encounter. Of those patients who had a DVT or PE, one patient received both LDUH and IPC. The remaining 34 patients who had a DVT or PE (97.1%) received only mechanical VTE prophylaxis.
Conclusion: Pharmacologic DVT prophylaxis rates were very low. The rate of DVT/PE was in line with other published rates. Pharmocologic DVT prophylaxis was superior to mechanical means alone. A large study documenting the safety and efficacy of pharmacologic DVT prophylaxis in these patients is needed.