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Mechanical and medical prophylaxis for venous thromboembolism (VTE) may need more attention to appropriateness in hospital settings, according to a statewide study from Michigan.

Low-risk patients, for whom no prophylaxis is recommended in American College of Chest Physicians guidelines, drove the excess risk, as 57.1% received anticoagulants and 77.9% overall got some form, Paul Grant, MD, of the University of Michigan Medical School in Ann Arbor, and colleagues reported in a research letter in .

The rate of excess use -- anticoagulants when there was a contraindication or combination with mechanical prophylaxis in any case -- in high-risk patients was 32.3% without a contraindication to prophylaxis and 26.9% with a contraindication to pharmacologic prophylaxis.

Individual hospitals varied from 8.2% to 84.6% for overuse in high-risk patients and from 15.5% to 99.6% in low-risk patients.

"Efforts aimed at improving VTE prophylaxis at local, regional, and national levels have been successful," the researchers noted, pointing to the only 22.0% rate of underuse of VTE prophylaxis.

"However, most interventions have focused on increasing overall rates of prophylaxis rather than overall appropriateness," leading to potential for bleeding, impaired mobility, falls, discomfort, and other adverse effects, the group cautioned.

"After years of promoting aggressive VTE prophylaxis strategies for hospitalized patients, renewed effort to scale back -- or 'deimplement' -- this practice in low-risk patients may be necessary," they concluded.

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