DVT Prophylaxis in Patients with Inflammatory Bowel Disease: Single-Center Retrospective Analysis of Care Appropriateness: 591

Introduction: Venous thromboembolism (VTE) is a significant cause of increased hospital cost, length of stay, morbidity and mortality among hospitalized inflammatory bowel disease (IBD) patients. Guidelines recommend pharmacologic VTE prophylaxis in most hospitalized IBD patients. We conducted a single center retrospective chart review of hospitalized patients to evaluate rate of adherence to current prophylaxis guidelines and identify risk factors associated with suboptimal prophylaxis. Methods: We performed a query of all IBD inpatient admissions from 2010-2015 via ICD 9 and 10 coding irrespective of admission diagnosis on both medical and surgical services. Patients age 18-90 were included. Exclusion criteria included palliative or hospice care, patients already on therapeutic anticoagulation, with prior VTE, and those admitted for orthopedic surgery with aspirin as VTE prophylaxis. Charts from 2009 were subsequently excluded due to paucity of data points. Charts of UC patients from 2015 were not analyzed due to EMR constraints. Data on IBD diagnosis, disease activity, patient demographics, laboratory profile including hemoglobin and platelet counts on admission, digital rectal exam (DRE) findings and type of VTE prophylaxis were collected. Prophylaxis with enoxaparin and unfractionated heparin were deemed as adequate. Prophylaxis with sequential compression device or none at all were deemed inadequate. Results: 717 admissions were analyzed, 325 (45.3%) patients had a diagnosis of UC and 392 (54.7%) patients had a diagnosis of CD. Adequate chemical VTE prophylaxis was started in 201 (68.1%) of CD patients and 94 (31.9%) UC patients. Total rate for all IBD patients was 41.1%. Following univariate data analysis, adequate VTE prophylaxis was more likely to be held in those patients with a diagnosis of UC as compared to CD [RR 1.77 (1.16 - 2.15) p=0.01]; age 18-35 [RR 0.73 (0.57 - 0.92) p=0.007]; hemoglobin < 8 mg/dL on admission [RR 0.46 (0.24 - 0.86) p=0.003]; testing hemoccult positive or having frank blood on DRE vs negative hemoccult or no DRE performed [RR2.93 (1.94 - 4.43) p < 0.0001]. Conclusion: Rate of initiation of adequate VTE prophylaxis in IBD patients is suboptimal at our institution. Our analysis shows that UC, active disease, hemoglobin less than 8 mg/dL, age less than 35, hemoccult positive or having frank blood on DRE were associated with being less likely to receive proper chemical VTE prophylaxis.