5PSQ-011 Assessing the misuse of thromboprophylaxis in hospitalised patients: a retrospective study

<h3>Background and Importance</h3> For inpatients, the risk of thromboembolic disease is significantly reduced through the administration of pharmacological thromboprophylaxis using either unfractionated heparin or low molecular weight heparin. The Padua score is validated in the literature for determining the indication for thromboprophylaxis. In our 450-bed healthcare facility, the therapeutic strategy for thromboprophylaxis is well-established and validated by the medical committee. <h3>Aim and Objectives</h3> The objective of the study is to determine the proportion of thromboprophylaxis misuse among patients who should receive this medication and to identify actions to address this issue. <h3>Material and Methods</h3> A retrospective analysis was carried out on the records of patients hospitalised for more than 3 days within our healthcare facility between January and June 2024. Patients with thrombocytopenia &lt;20G/L, active severe haemorrhage, or those already receiving therapeutic anticoagulation were excluded. All prescriptions, medical and surgical history, morphological data, medical and paramedical observations, and biological results were reviewed. <h3>Results</h3> Among 1,684 eligible patients, 204 were randomly selected. After analysis, 72 patients were excluded: 52 were receiving therapeutic-dose anticoagulants, and 20 had insufficiently documented records. Among the 132 included patients, 17 (12.9%) were not treated despite having an indication according to the Padua score. Six patients (4.5%) were treated with an insufficient dose – enoxaparin 4,000 IU/day in morbidly obese patients – resulting in a total underuse rate of 17.4%. Two cases of overdosing were identified: enoxaparin 4,000 IU/day instead of 2,000 IU/day in patients with severe renal impairment or low body weight. Thromboprophylaxis misuse affected 18.9% of patients. <h3>Conclusion and Relevance</h3> A limitation of this study is its retrospective nature, which includes challenges in determining whether a patient is bedridden for the calculation of the Padua score. Despite routine pharmaceutical analysis, misuse was identified in nearly one out of five patients. The pharmacy team was informed, and a rapid training session on the systematic use of the Padua score was organised. A systematic approach to detect thromboprophylaxis misuse through the modelling of clinical situations within a pharmaceutical decision support system is currently being evaluated. <h3>References and/or Acknowledgements</h3> Barbar. A risk assessment model for the identification of hospitalised medical patients at risk for venous thromboembolism: the Padua Prediction Score. <i>J Thromb Haemost</i>. 2010;<b>8</b>(11):2450–7 <h3>Conflict of Interest</h3> No conflict of interest