Are Hospitals Following Guidelines for VTE Prevention? the Veneous Thromoembolism Study to Assess the Rate of Thromboprophylaxis

OBJECTIVE: The 7^th conference of the American College of Chest Physicians (ACCP7) provides evidence-based guidelines on the type, dose, and duration of thromboprophylaxis in hospitalized patients at risk of venous thromboembolism (VTE), but the extent to which hospitals follow these criteria has not been well studied.

METHODS: Discharge and billing records for patients admitted to any of 16 rural and urban U.S. acute-care hospitals from January 2005 to December 2006 were obtained. Patients 18 years or older who had an inpatient stay ³2 days and no apparent contraindications for thromboprophylaxis were grouped into the categories of critical care, surgery and medically ill before being assessed for additional VTE risk factors based on the diagnostic criteria outlined in ACCP7. For patients considered “at risk”, the recommended type (mechanical or pharmacologic), dose, and duration of thromboprophylaxis was identified based on the guidelines and compared to the regimen actually received, if any.

RESULTS: Among the 258,556 hospitalized patients, 68,278 (26.4%) were determined to be at risk of VTE without apparent contraindications for thromboprophylaxis. The proportions of patients who received the appropriate type and dose and duration of thromboprophylaxis were 10.5%, 9.8%, and 17.9% for critical care, medical, and surgical patients, respectively. Of those at risk, 36.8% received no thromboprophylaxis and an additional 50.2% received thromboprophylaxis deemed inappropriate for one or more reasons.

CONCLUSIONS: The implementation of ACCP7 guidelines for type, dosage, and duration of thromboprophylaxis is low in patients at risk of VTE. Fewer than 1 in 7 patients received thromboprophylaxis that met criteria for recommended type, dose and duration. The findings demonstrate a worrisome gap in the performance of evidence-based thromboprophylaxis for hospitalized patients. There is a need for physicians and health systems to improve the levels of awareness and implementation of recommended thromboprophylaxis.