Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 12;9(15):3929-3936.
doi: 10.1182/bloodadvances.2024015306.

Inaccuracies of venous thromboembolism risk assessment and prevention practices among medically ill patients

Brandyn D Lau  1   2   3 , Aditya Bhave  4 , Jennifer C Yui  5 , Rakhi Naik  5 , Kathryn E Dane  6 , John Lindsley  6 , Dauryne L Shaffer  7   8 , Peggy S Kraus  6 , Erik H Hoyer  9 , Elliott R Haut  2   3   10   11   12 , Michael B Streiff  2   5
Affiliations

Inaccuracies of venous thromboembolism risk assessment and prevention practices among medically ill patients

Brandyn D Lau et al. Blood Adv. .

Abstract

Venous thromboembolism (VTE) is a common cause of preventable harm among hospitalized, medically ill patients. The purpose of this study is to evaluate the accuracy of Padua VTE risk assessments, VTE prevention practices, and outcomes. In this retrospective analysis of consecutively hospitalized, medically ill patients at Johns Hopkins Hospital from 1 January through 30 April 2019, a hematologist subject matter expert (SME) retrospectively completed a Padua VTE risk assessment for every patient. Results were compared with risk assessments completed by the admitting provider. The primary outcome was agreement between the SME and admitting provider on overall VTE risk. Secondary outcomes included agreement on VTE risk factors, risk-appropriate VTE prophylaxis prescription and administration, and VTE outcomes. Of the 4021 patients included, agreement between admitting providers and the SME on overall VTE risk was 65.3%. The SME identified 1156 patients (28.7%) as high risk who were categorized on admission as low risk. Risk factors with the lowest agreement were reduced mobility and acute infection. A total of 2141 patients (53.2%) were prescribed appropriate VTE prophylaxis. Thirty-six patients developed in-hospital VTE, including 21 who had been misclassified as low risk. Significantly more doses of prescribed VTE prophylaxis were not administered among patients who developed VTE (19.6% vs 15.2%; P = .007). Inaccurate VTE risk assessment leads to inappropriate VTE prevention practices and preventable VTE. Leveraging existing structured data to autopopulate VTE risk assessments can assist providers in improving accuracy. Quantitative measures of patient mobility should be incorporated into VTE risk assessment.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: M.B.S. has consulted for Attralus, Bristol Myers Squibb, CSL Behring, Janssen, and Pfizer; and has given expert witness testimony in various medical malpractice cases. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Determination of risk-appropriate VTE prophylaxis prescription. q12h, every 12 hours.
See this image and copyright information in PMC

References

    1. DHHS . U.S. Department of Health and Human Services; 2008. The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. - PubMed
    1. Streiff MB, Lau BD. Thromboprophylaxis in nonsurgical patients. Hematol Am Soc Hematol Educ Program. 2012;2012(1):631–637. - PubMed
    1. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ, American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines [published correction appears in Chest. 2012;142(6):1698] Chest. 2012;141(suppl 2):7S–47S. - PMC - PubMed
    1. Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010;8(11):2450–2457. - PubMed
    1. Nendaz M, Spirk D, Kucher N, et al. Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit ASsessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE) Thromb Haemost. 2014;111(3):531–538. - PubMed