Title : Improving compliance with venous thromboembolism prophylaxis prescribing in cardiology inpatients: a prospective re-audit
Abstract:
Background
Venous thromboembolism (VTE) prophylaxis is an important patient-safety process in acutely admitted cardiology patients, where immobility, heart failure, myocardial infarction and invasive cardiac procedures can increase thrombotic risk while complex antithrombotic regimens may create prescribing uncertainty. A previous audit of 510 cardiology inpatients showed suboptimal prescribing on admission, with appropriate prophylaxis or a valid reason documented in 53% of patients, 28% experiencing delayed prescribing, and 18.6% never receiving prophylaxis without a valid reason.
Objectives
To assess whether VTE prophylaxis prescribing improved following the first audit cycle and to identify persistent causes of omission or delay.
Methods
A prospective re-audit was undertaken of 200 consecutive patients admitted under cardiology between 10 June and 10 July 2026. Eligible patients were admitted for a cardiac-related diagnosis. Data were collected on admission date, ward, diagnosis, enoxaparin prescribing at admission, dose accuracy, delayed prescribing, documented reason for non-prescription, and VTE events during admission or within four weeks of discharge.
Results
Overall, 127/200 patients (63.5%) had enoxaparin prescribed at admission. Among 73 patients not prescribed prophylaxis at admission (36.5%), 28 (38.4%) had a valid documented reason, most commonly direct oral anticoagulant therapy (n=15), warfarin (n=7) or fondaparinux (n=3); other reasons included thrombocytopenia (n=2) and aortic dissection (n=1). Therefore, 155/200 patients (77.5%) were either prescribed prophylaxis at admission or had a valid reason for omission, compared with 53% in the first cycle. Of the 45 patients without a valid initial reason, 34 were subsequently prescribed prophylaxis: 11 after one day, nine after two days, nine after three days and five after five days. Eleven patients (5.5%) had ongoing omission without a valid documented reason, reduced from 18.6% previously. All prescribed doses were appropriate, improving from approximately 95% in the first cycle to 100% in the re-audit. No inpatient VTE events or VTE-related readmissions within four weeks were identified.
Conclusions
The re-audit shows a clear improvement in admission prescribing and dose accuracy, with fewer delayed prescriptions and fewer unexplained omissions. However, delayed recognition remains an issue, particularly when patients are not anticoagulated on admission. Embedding an admission proforma prompt, reinforcing guidance around antithrombotic overlap, and continuing pharmacist/doctor feedback may help convert improvement into reliable routine practice.
