2026 Southeastern Residency Conference

Primary Author: Charles Pitts
Co-Authors: Hope Allen, Brittany Till, Morgan Moulton, Perry Thompson, Walter Minger, Tiffany Lyght

Background: Venous thromboembolism (VTE) is a common cardiovascular diagnosis, with many cases linked to recent hospitalizations. Prophylactic anticoagulation is used to prevent VTE, guided by patient risk factors. Risk Assessment Models (RAMs), such as the Padua VTE RAM, help determine when VTE prophylaxis is appropriate or should be avoided due to bleed risk, as recommended by the American Society of Hematology. This project was designed to evaluate the current utilization of prophylactic anticoagulation using the Padua VTE RAM to determine its appropriateness in patients admitted to the inpatient setting. According to the Padua RAM, scores of 4 or more are indicative of high VTE risk and should receive anticoagulation.

Methods: This project was a retrospective, observational review of Veterans' charts who received prophylactic anticoagulation in the inpatient setting within the Central Alabama Veterans Health Care System (CAVHCS). Data collected included Veteran demographics, active prescriptions, ICD codes, recent surgeries, age, body mass index (BMI), birth sex, kidney function, presence of a central venous catheter, critical care admissions, liver function tests, platelet counts, and recent bleeding events. The data was compiled in a de-identified Microsoft Excel spreadsheet for analysis. The primary outcome assessed was the percentage of Veterans appropriately placed on prophylactic anticoagulation based on inclusion/exclusion criteria. Secondary outcomes included the number of admitted Veterans receiving prophylactic anticoagulation who experienced bleeding-related events and thrombosis-related events.

Results: One hundred Veteran charts were evaluated for this project. Of the evaluated charts, prophylactic anticoagulation was appropriately administered or withheld in 53 Veterans and prophylactic anticoagulation was inappropriately administered or withheld in 47 Veterans based on their individual Padua RAM scores. Of the 47 Veterans, 45 received inappropriate prophylactic anticoagulation and two Veterans had prophylactic anticoagulation withheld inappropriately. None of the Veterans evaluated experienced bleed or thrombosis-related events.

Conclusions: Nearly 50% of Veterans reviewed had anticoagulation inappropriately administered or withheld while admitted. While this evaluation did not find any bleed or thrombosis-related events, the current anticoagulation prescribing trends leave room for improvement. The creation of a policy to standardize the criteria for VTE prophylaxis could increase appropriate anticoagulation prescribing patterns within the CAVHCS inpatient setting. This project also exposes an area of Veteran healthcare that Clinical Pharmacy Practitioners could assist in optimizing and monitoring.