Venous thromboembolism prophylaxis in acutely ill medical patients: definite need for improvement.
OBJECTIVE
To examine the frequency and adequacy of thromboprophylaxis in acutely ill medical patients hospitalized in eight Swiss medical hospitals.


METHODS
A cross-sectional study of 1372 patients from eight Swiss hospitals was carried out. After exclusion of patients (275) given therapeutic anticoagulation, 1097 patients were audited. The adequacy of thromboprophylaxis was assessed by comparison with predefined explicit criteria.


RESULTS
Of 1097 patients, 542 (49.4%) received thromboprophylaxis. According to the explicit criteria, 644 (58.7%) should have been on prophylaxis (P < 0.001, when compared with the rate observed). The rate of prevention differed widely between hospitals (from 29.4 to 88.6%) with no difference between teaching and nonteaching hospitals. According to the explicit criteria, a substantial proportion (44.9%) of the patients who should have been treated were not. Conversely, 41.3% of the patients were unnecessarily treated.


CONCLUSIONS
Even though the appropriateness of the explicit criteria used could be challenged, our data suggest that the current practice is associated with important uncertainty leading to both overuse and underuse of thromboprophylaxis in patients hospitalized in medical wards. More efforts are urgently needed to develop new or endorse existing explicit, evidence-based criteria and guidelines for thromboprophylaxis in this population of patients.
Chopard
P
P
Faculty of Medicine, University Hospitals, Geneva, Switzerland. pierre.chopard@hcuge.ch
Dörffler-Melly
J
J
Hess
U
U
Wuillemin
W A
WA
Hayoz
D
D
Gallino
A
A
Bachli
E B
EB
Canova
C R
CR
Isenegger
J
J
Rubino
R
R
Bounameaux
H
H
D000208:Acute Disease; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000592:standards; D011655:Pulmonary Embolism / Q000517:prevention & control*; D011787:Quality of Health Care; D013557:Switzerland; D020246:Venous Thrombosis / Q000517:prevention & control*