The Clot Stops Here: Insights Into Venous Thromboembolism Prophylaxis Adherence From Two Cases

Pharmacologic venous thromboembolism (VTE) prophylaxis is effective and essential in the inpatient setting for medically ill patients to prevent deep venous thromboses (DVTs) and pulmonary embolisms (PEs), especially in high-risk patients such as those with limited mobility and underlying malignancy. It is less clear how the primary team, including the nurses and physicians, work together to ensure adherence to VTE prophylaxis during hospitalizations, especially amongst different institutions with varied practices. This case series describes two cases of healthcare-associated VTE after refusal of VTE prophylaxis for several days and the resulting complications, including morbidity and mortality. In light of these two cases and recognition that healthcare-associated VTE is a wider public health problem, we suggest a multi-disciplinary and standardized protocol for physicians to follow to ensure VTE prophylaxis adherence that takes into account a VTE risk assessment calculator such as the Padua or Caprini scores. Furthermore, physicians should acknowledge VTE prophylaxis refusal, counsel patients, and document their findings in high-risk patients on a daily basis. This would be a full-circle approach that encourages patient education about this commonplace yet critical practice and the potential consequences of non-adherence.