VTE Prophylaxis Is Underused in the U.S. and Worldwide

In the U.S., 40% of patients who were at risk for venous thromboembolism did not receive prophylaxis.
Pulmonary embolism is the most common preventable cause of in-hospital death. Pharmacologic prophylaxis for venous thromboembolism (VTE) lowers risk for pulmonary embolism by 57% in medical patients and by 75% in general surgical patients; the American College of Chest Physicians (ACCP) offers regularly updated guidelines on VTE prophylaxis. Nevertheless, many at-risk patients do not receive VTE prophylaxis.
Investigators conducted 1-day cross-sectional surveys of acute-care wards in 358 randomly selected hospitals in 32 countries on six continents; they assessed the number of patients who were at risk for VTE by ACCP criteria and the proportions who received recommended VTE prophylaxis. More than 68,000 patients were assessed (45% medical; 55% surgical); 42% of medical patients and 64% of surgical patients were deemed to be at risk for VTE. Of these at-risk patients, 40% of medical patients and 59% of surgical patients received recommended prophylaxis. Among at-risk patients in the U.S., 48% of medical patients and 71% of surgical patients received recommended prophylaxis.
Comment: Although the percentage of U.S. at-risk patients who receive VTE prophylaxis exceeds worldwide averages, it is still abysmally smaller than it should be. The authors sensibly recommend hospital-wide strategies to improve assessment of VTE risk and to increase delivery of recommended prophylaxis, and editorialists call on all medical and surgical societies to incorporate VTE assessment and prophylaxis into their disease-management guidelines.
— Bruce Soloway, MD
Published in Journal Watch General Medicine February 26, 2008
Citation(s):
Cohen AT et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): A multinational cross-sectional study. Lancet 2008 Feb 2; 371:387.