Background Venous thrombosis and pulmonary embolism are potentially preventable causes of hospital-related morbidity and mortality. Thromboprophylaxis is thought to be underused in medical inpatients. The PRETEMED guide is a risk assessment tool used to quantify the risk of venous thromboembolism (VTE) in medical inpatients.

Purpose To evaluate the appropriateness of VTE prophylaxis in medical inpatients and to describe Pharmacy Interventions to improve this treatment.

Material and methods Cross-sectional study in a medical ward in a public hospital with 120 beds. VTE risk factors and VTE prophylaxis prescribed were assessed in patients admitted from the emergency department. Patients treated with low molecular weight heparin (LMWH) or enoxaparin for therapeutic purposes were excluded. The PRETEMED guide was used as a risk assessment tool to evaluate the appropriateness of the prophylaxis given to patients.

Results 168 patients were analysed and 113 included in the study with indications for VTE prophylaxis, 60 of them (53%) were men, mean age 75 years (SD 18.3). According to the PRETEMED guide, 13.3% of patients had low risk of VTE, 6.2% moderate and 80.5% high. In 49 patients (43%) there were discrepancies between the VTE prophylaxis prescribed and the PREMETED guide recommendation: 32% treatment omission, 7% no treatment indication and 4% overdoses.

Thirty-one pharmacy interventions in 27% of patients were made during this period. Sixteen (52%) were related to the need for LMWH and fifteen (48%) to the dose of enoxaparin prescribed (wrong dose, wrong frequency or adjustment for renal impairment needed). Twenty-three (74%) of them were accepted, 14 were treatment initiation and 9 were dose adjustments.

Conclusion In almost half of the patients included in the study the VTE prophylaxis prescriptions did not agree with the PRETEMED guide recommendations and most of them were related to treatment omission. Pharmacists improved patients’ treatment by working with the assistants’ team in making interventions that were mostly accepted.

References and/or Acknowledgements No conflict of interest.