A Pilot study, for mandatory Venous Thromboembolism (VTE) Risk Assessment and Prophylaxis Implementation for cost effectively improving VTE outcomes in hospitalized medical patients

This pilot study will assess the feasibility and logistics of conducting a study to assess the efficacy and cost effectiveness of implementing mandatory venous thromboembolism (VTE) risk assessment and consequent guideline-dictated VTE prophylaxis, on the prevention of VTE in hospitalised medically ill patients. The study will randomise consecutive medically ill hospital admitted patients to a control group or an intervention group. The intervention group will be risk assessed according to American Collage of Chest Physicans (ACCP) guidelines and thence prescribed or not prescribed VTE prophylaxis according to ACCP recommendations. Patients in the control group will have no intervention and will thus receive standard care which may or may not include VTE risk assessment and prophylaxis. Patients in both groups will be followed up for 90 days from randomization for thrombotic events or death from any cause. Bleeding events during hospitalisation will be collected. VTE, bleeding and prophylaxis related costs will be estimated. For all patients in the intervention group, their VTE risk will be assessed according to the ACCP guidelines within 24 hours of their admissions. On the basis of that risk assessment effort will be made to ensure that VTE prophylaxis is implemented and customised to be compliant with ACCP guidelines i.e. 1. If patient is assessed by ACCP guidelines as not high risk, prophylaxis will not be given 2. If patient is assessed by ACCP guidelines as ‘high’ risk AND has no contraindication to anticoagulant therapy, chemical prophylaxis (anticoagulant drug and dose determined by patient's doctor) will be given throughout hospitalisation 3. If patient is assessed by ACCP guidelines as ‘High’ risk AND has contraindication to anticoagulant therapy, mechanical prophylaxis will be implemented throughout hospitalisation.