A Review of Venous Thromboembolism Prophylaxis for Hospitalized Medical Patients

Abstract

In the last decade, greater focus has been directed toward venous thromboembolism (VTE) prophylaxis in hospitalized, non-surgical patients. Both deep venous thrombosis and pulmonary embolism are potentially preventable causes of patient morbidity and mortality related to hospitalization. Despite the availability of high-quality, evidence-based guidelines for VTE prevention, there is compelling evidence that many hospitalized patients do not receive appropriate VTE prevention measures. Hospitalists play an important role in the implementation of appropriate VTE prophylaxis measures for this patient population; thus, knowledge of updated recommendations is vital to their practice, as well as patient safety. We provide a comprehensive evidence-based clinical review of VTE prophylaxis for nonsurgical hospitalized patients, including risk factors and risk assessment, indications for prophylaxis, recommended therapeutic options, and updates from recently released practice guidelines by the American College of Physicians and the American College of Chest Physicians, published in 2011 and 2012, respectively.

Comparisons Between Upper and Lower Extremity Deep Vein Thrombosis: A Review of the RIETE Registry

“…1 The Joint Commission and National Quality Forum monitors VTEs as one of its core performance measures, specifically VTE prophylaxis. 2 The occurrence of lower extremity deep vein thrombosis (LEDVT), averaging approximately 187 000 cases per year in the United States, is considered the third most frequent vascular disease after myocardial infarction and stroke. 3,4 Patients with acute LEDVT may have risk factors such as surgery, prolonged length of procedures, weakness or paresis, malignancy, and advanced age.…”

Venous thromboembolism prophylaxis for hospitalized adult patients: a survey of US health care providers on attitudes and practices

“…Despite consensus guidelines recommending thromboprophylaxis for at-risk patients in the hospital [ [8] , [9] , [10] ], appropriate thromboprophylaxis remains underutilized or misapplied. Studies suggest that those at the highest risk are inadequately covered and the majority of patients receiving thromboprophylaxis may not truly be at sufficient risk [ [11] , [12] , [13] ].…”

Low to Moderate Risk Non-orthopedic Surgical Patients Do Not Benefit From VTE Chemoprophylaxis

“…Evidence from multiple historical randomized clinical trials and meta-analyses has shown chemoprophylaxis in high-risk hospitalized surgical patients is safe and effective for reducing VTE. [5][6][7][8][9][10] However, evidence may not be broadly adopted, [11][12][13] and population-based studies have shown little decline in either VTE incidence 14 or case fatality. 15,16 Conversely, a large administrative database review showed no correlation between prophylaxis rates and VTE, in part due to surveillance bias.…”