Venous thromboembolism: application and effectiveness of the American College of Chest Physicians 2001 guidelines for prophylaxis.
BACKGROUND
Guidelines on the use of prophylaxis in venous thromboembolism (VTE) are poorly implemented in clinical practice.


OBJECTIVE
To evaluate the extent to which the American College of Chest Physicians (ACCP) 2001 guidelines on VTE prophylaxis are adhered to in clinical practice by determining whether patients admitted to a medical center with an objective diagnosis of VTE had received adequate prophylaxis.


METHODS
The medical records of medical and surgery patients with an objective diagnosis of VTE were reviewed. Patients were classified as having either preventable or nonpreventable VTE according to indication for prophylaxis, VTE risk, and adequacy of prophylaxis if administered. Adequacy was determined by adherence to the ACCP 2001 guidelines.


RESULTS
Of 44 patients, 17 (38.6%) had not received adequate prophylaxis and were classified as having potentially preventable VTE. Venous thromboembolism developed in the remaining 27 (61.4%) patients despite adequate prophylaxis. In general, adequate prophylaxis rates were lower among surgery patients compared with medical patients. Four (80%) of the very-high-risk surgery patients received inadequate prophylaxis. The most common VTE risk factor in both categories was immobility.


CONCLUSIONS
Adherence to the ACCP guidelines is suboptimal, with a substantial proportion of patients with VTE receiving inadequate prophylaxis. The additional finding that the incidence of VTE is high despite adequate prophylaxis indicates that the guidelines may need to be reevaluated.
Steier
Kenneth J
KJ
Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554-1859, USA. ksteier@numc.edu
Singh
Geeta
G
Ullah
Asmat
A
Maneja
Jennifer
J
Ha
Rose Sanghee
RS
Khan
Farhan
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D009518:New York; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control*
D000925:Anticoagulants