Expedited discharge in trauma patients requiring anticoagulation for deep venous thrombosis prophylaxis

The leap program

Gail G. Bridges, Marilyn D. Lee, J. Kimble Jenkins, Mark A. Stephens, Martin Croce, Timothy Fabian

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective With rising health care costs, methods to decrease length of hospital stay without compromising care are necessary. One area that extends length of stay in trauma patients is inpatient anticoagulation to a therapeutic international normalized ratio. The 1998 American College of Chest Physicians guidelines recommend thromboprophylaxis with low-molecular-weight heparin (LMWH) and oral warfarin in this population. The LMWH Expedited Anticoagulation Program (LEAP) was created with the following goals: to decrease the number of inpatient warfarin days and to reduce overall number of hospital days.Methods Inpatient anticoagulation was initiated with warfarin and LMWH. LEAP included early multidisciplinary collaboration to ensure third-party approval, outpatient primary care physician follow-up, and LMWH self-injection before discharge. Patients were discharged on LMWH (discontinued by primary care provider when a therapeutic international normalized ratio was attained) and warfarin (continued until resolution of orthopedic injuries). From August 2000 to August 2001, adult patients were included in the prospective study. Primary inclusion criteria were blunt acetabular fracture, bilateral lower extremity fracture, and contralateral upper and lower extremity fractures. Patients with similar injuries receiving warfarin for deep venous thrombosis prophylaxis between June 1999 and June 2000 were the control population. Anticoagulation care was similar for the study and control subjects.Results There were 182 patients evaluated for LEAP inclusion. After initial evaluation, 108 patients were enrolled in LEAP (Injury Severity Score of 13). There were 69 control subjects (Injury Severity Score of 13). The average number of inpatient warfarin days was decreased from 8.8 days to 5.0 days in the control and study populations, respectively (p < 0.0001). The average length of hospitalization was shortened from 17.3 days in the control group to 12.9 days in the study (LEAP) population (p < 0.002).Conclusion LEAP has successfully decreased the number of inpatient days on warfarin and total hospital days for trauma patients requiring deep venous thrombosis prophylaxis. These results have substantially decreased health care costs and increased available hospital beds in this era of high hospital occupancy.

Original languageEnglish (US)
Pages (from-to)232-235
Number of pages4
JournalJournal of Trauma
Volume54
Issue number2
DOIs
StatePublished - Jan 1 2003

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Low Molecular Weight Heparin
Venous Thrombosis
Warfarin
Wounds and Injuries
Inpatients
Length of Stay
Injury Severity Score
International Normalized Ratio
Health Care Costs
Lower Extremity
Population
Population Control
Primary Care Physicians
Ambulatory Care
Orthopedics
Primary Health Care
Hospitalization
Prospective Studies
Guidelines
Control Groups

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Expedited discharge in trauma patients requiring anticoagulation for deep venous thrombosis prophylaxis : The leap program. / Bridges, Gail G.; Lee, Marilyn D.; Jenkins, J. Kimble; Stephens, Mark A.; Croce, Martin; Fabian, Timothy.

In: Journal of Trauma, Vol. 54, No. 2, 01.01.2003, p. 232-235.

Research output: Contribution to journalArticle

Bridges, Gail G. ; Lee, Marilyn D. ; Jenkins, J. Kimble ; Stephens, Mark A. ; Croce, Martin ; Fabian, Timothy. / Expedited discharge in trauma patients requiring anticoagulation for deep venous thrombosis prophylaxis : The leap program. In: Journal of Trauma. 2003 ; Vol. 54, No. 2. pp. 232-235.
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