ANTICOAGULATION THERAPY IN PATIENTS WITH VENOUS THROMBOEMBOLIC DISEASE

OBJECTIVE: To determine, in a representative sample of patients drawn from a variety of hospitals, the degree of adherence to consensus reco mmendations for anticoagulation among patients with deep vein thrombos is or pulmonary embolism. DESIGN: Cross-sectional review of a populati on-based random sample. SETTING: Twenty-one randomly selected Pennsylv ania hospitals. PATIENTS: Of 357 randomly selected Medicare beneficiar ies discharged from study hospitals with a diagnosis of deep venous th rombosis or pulmonary embolism during 1992, 43 charts were not reviewe d for administrative reasons, 31 were miscoded or not treated with int ravenous administration of heparin, and 13 were excluded for other rea sons, leaving 270 in the final sample. MEASUREMENTS AND MAIN RESULTS: Overall, 179 patients (66%, 95% confidence interval [CI] 59%, 72%) rec eived therapeutic anticoagulation (two consecutive partial thromboplas tin times more than 1.5 times control) within 24 hours of starting hep arin. Platelet counts were checked at least once during the first week of heparin therapy in 66% (95% CI 58%, 74%). At least 5 days of hepar in therapy was given to 84% (95% CI 79%, 87%). Among 266 (99%) of the patients receiving warfarin, 193 (72%; 95% CI 63%, 80%) received hepar in until the prothrombin time ratio or International Normalized Ratio was therapeutic. Patients who were started on warfarin therapy within 2 days of heparin had decreased length of stay (geometric mean 8.2 vs 9.7 days, p = .003), Compliance varied among hospitals. CONCLUSIONS: I n a wide variety of hospitals, we found fair, but variable, compliance with consensus recommendations for anticoagulation of patients with v enous thromboembolic disease. Simple interventions to improve complian ce with these recommendations might improve quality of care and reduce costs.