Thromboprophylaxis in Hospitalized Patients with Human Immunodeficiency Virus
Highlights from the 12th National Conference on Anticoagulant Therapy.
Michael Streiff, MD, a member of the Medical & Scientific Advisory Board of National Blood Clot Alliance was one author of a poster entitled “Evaluation of Non-administration of Thromboprophylaxis in Hospitalized Patients with Human Immunodeficiency Virus.” The background states that the rate of VTE (venous thromboembolism) in patients with HIV has been observed to be 2 to 10 fold higher than in patients without HIV. Factors linked to increased HIV risk include advancing HIV/AIDS (virologic, immunologic progression), opportunistic infections, malignancy, protein S and/or Protein C deficiency, and intravenous drug use. An order set was implemented at Johns Hopkins Hospital in Baltimore, MD in December 2007 which led to increased prescription of thromboprophylaxis and decreased incidence of symptomatic VTE (venous thromboembolism). Conclusions were:
- Overall, patients with HIV received fewer ordered doses of thromboprophylaxis compared with patients without HIV.
- Overall, patients with HIV more often refused doses of thromboprophylaxis compared with patients without HIV.
- When considering each individual nursing unit, a minority of units account for these differences.
- The results suggest that unit culture may play an important role in administration and refusal rates.
- Potential interventions may be targeted to those units in which high rates of non-administration were observed.
Dr Streiff said he thinks that nurse–patient interaction affects a hospital unit’s culture, that this particular unit had a low turnover, and that the culture is an element for future investigation or assessment. This information will further define the preventive care needs of patients with HIV, which may include more aggressive thromboprophylaxis.
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