Deep vein thrombosis prophylaxis in long-term care facilities--perhaps less is more.

摘要

To the Editor: We found the query posed by Drs Dharmarajan and Nor-kus quite noble and intriguing. Although the premise of implementing venothromboemoblic prophylaxis among "high-risk" residents in long-term care facilities is certainly tempting, one cannot help but ponder the extent of fiscal and, not to mention, logistical repercussions of newly established guidelines in such a population. With annual increases in comorbidities and high rates of hospitalizations, one could speculate that a vast number of patients would fall under this arbitrary "high-risk" category for the development of venothromboemoblics. However, as is well known, the implementation of mechanical and chemical anticoagulation in this morbidly overwhelmed population is especially challenging and, not to mention, costly. Projected iatrogenic complications ensuing from falls and subsequent bleeding diathesis with accompanying polyphar-macy management may overwhelm the potential health, quality-of-life, and fiscal benefits gleaned from such intervention. ' Although it is certainly not our intention to deter our esteemed colleagues from pursuing quality improvement measures, we wonder if extending a high-risk prophylactic modality would open the proverbial Pandora's box of problems in this already vulnerable patient population. In the setting of limited data and many confounding elements revolving mortality in this group, perhaps we can stipulate, less is more.