Cystic Fibrosis and Sickle Cell Disease Associated with Non-administration of VTE Prophylaxis in Hospitalized Adults

Cystic fibrosis (CF) and sickle cell disease (SCD) are associated with increased risk of venous thromboembolism (VTE), and this risk is exacerbated by hospitalization. VTE prophylaxis non-administration is a VTE risk factor. The objective of this study was to characterize VTE prophylaxis non-administration among patients with either CF or SCD compared to medically ill patients without CF or SCD. We conducted a single-center retrospective cohort study of hospitalized patients who were prescribed at least 2 doses of pharmacologic VTE prophylaxis. The primary outcome was the proportion of non-administered VTE prophylaxis doses by cohort. Multivariable logistic regression was used to identify characteristics associated with non-administration. A total of 13,316 patients were included; 89 with CF, 246 with SCD, and 12,981 other-medically ill. During the study period, 95,697 doses were prescribed; non-administration rates were 61.8% in the CF cohort, 32.7% in the SCD cohort, and 19.7% in the medically ill cohort (p<0.01). In the multivariable logistic regression, CF or SCD diagnosis [odds ratio (OR) 2.03, 95% confidence interval (CI) 1.59-2.6], multiple admissions (OR 2.4, 95% CI 2.19-2.64), and >5 prescribed doses of VTE prophylaxis (OR 2.48, 95% CI 2.29-2.69) were associated with non-administration of one or more doses. The percent of missed doses (median, IQR) per patient was highest in the CF cohort (66.7%, 84.5), followed by the SCD cohort (10.6%, 50), and medically ill cohort (0%, 16.7, p<0.01). These findings suggest strategies to improve VTE prophylaxis administration rates during acute hospitalization in high-risk conditions such as CF and SCD are needed.