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The look back at how patients were treated between and also found wide-ranging variability in use and dosing of prophylactic anticoagulation across US hospitals. The study was published this week online ahead of print in the Journal of the American Heart Association. Large Variation in Prescribing and Dosing. Of those who did receive it, the most commonly used agents were unfractionated heparin and low-molecular-weight heparin. Compared with patients who received anticoagulation, those who did not were younger, more often white and women, and tended to have fewer comorbidities as well as lower levels of C-reactive protein and ferritin.

Patients who received full-dose versus low-dose anticoagulants were more often men, had higher rates of diabetes and hypertension, and had higher levels of natriuretic peptide, C-reactive protein, and ferritin. The possibilities that a patient would receive any versus no anticoagulation or a full versus low dose were 2. These odds did not change over the study period. In multivariable analysis, patient-level and hospital-level factors associated with an increased odds of anticoagulation included older age, male sex, nonwhite race, higher BMI, higher platelet count, corticosteroid use, and ICU admission.

Similarly, patient- and hospital-level factors associated with an increased odds of receiving full-dose anticoagulation included older age, male sex, higher BMI, higher platelet count, corticosteroid use, ICU admission, and need for mechanical ventilation.

By region, patients at hospitals in the Midwest had the lowest likelihood of receiving any anticoagulation, with wide variation seen among the other regions. To TCTMD, Lopes said a surprising and disappointing finding was that there was an increase in the proportion of patients who received no anticoagulation over the study period, up to and including February Another potential possibility is that clinical inertia was at play.