Who says "no" - Patient-specific risk factors for refusal of venous thromboembolism chemoprophylaxis in hospitalized patients.

BACKGROUND

Venous thromboembolism (VTE) increases morbidity and mortality for hospitalized patients. VTE chemoprophylaxis mitigates the risk of VTEs; however, missed doses are common. The purpose of this study was to investigate patient-specific risk factors for refusal of VTE chemoprophylaxis.

METHODS

This was a retrospective, case-control study conducted at a large academic medical center. Adult, hospitalized patients (7/1/2021-6/30/2023) with active orders for VTE chemoprophylaxis were screened for inclusion. Patients on therapeutic anticoagulation or anticoagulated with fondaparinux were excluded. Patients with 0-1 and greater than 2 refused doses were cohorted into "Non-Refusal" and "Refusal" groups, respectively. Regression analysis was used to assess potential risk factors associated with refusal of VTE chemoprophylaxis for the primary outcome. Rates of refusal were compared by hospital unit for the secondary outcome.

RESULTS

18,711 patients were included in final analysis, 16,599 in the "Non-Refusal" group and 2,112 in the "Refusal" group. Characteristics associated with increased risk of VTE chemoprophylaxis refusal were Black race, English-preferred language, former/current smoker, and substance use disorder. Hispanic ethnicity and increasing age were associated with a decreased risk of refusal. There were no statistically significant associations between gender, place of residence, or psychiatric diagnoses and refusal. When compared across hospital units, rates of VTE chemoprophylaxis refusal varied.

CONCLUSION

This study identified several patient-specific characteristics associated with increased and decreased risk of VTE chemoprophylaxis refusal. Additionally, variance in rates of refusal was noted across hospital units. Identification of factors associated with VTE chemoprophylaxis refusal may help inform targeted interdisciplinary education and intervention strategies.