Evaluation of the efficacy of venous thromboembolism prophylaxis guideline implementation in Japan.
OBJECTIVE
In Japan, the incidence of venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), has been relatively low; however, the incidence has recently been increasing. Since April 2004, we have developed an original computer-linked VTE prophylaxis in order to decrease the incidence of in-hospital VTE. Our objective has been to evaluate the efficacy of the VTE prophylaxis guideline.


METHODS
A retrospective pre- and postintervention study was conducted (preintervention phase, n = 17 854; postintervention phase, n = 26 831). Data were obtained from the clinical records of patients who underwent vascular surgery and were screened for DVT at our institution.


RESULTS
The frequency of patients screened for DVT increased significantly from 70 (0.4%) to 209 (0.8%) after the establishment of a guideline (P < 0.001). Asymptomatic DVT patients increased from 5 (12.5%) in the control group to 33 (50.0%) in the intervention group (P < 0.0001), while symptomatic DVT events with leg swelling decreased from 29 (72.5%) to 16 (24.2%) (P < 0.0001). Furthermore, shock and massive PE events were significantly lower (from 31.3% to 0%; P < 0.05).


CONCLUSIONS
Our VTE prophylaxis guidelines are considered to be useful for the detection of asymptomatic DVT patients during hospitalization, thus leading to a significantly lower incidence of postoperative VTE.
Division of Vascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan.
Kiyoaki
K
Niimi
Masayoshi
M
Kobayashi
Hiroshi
H
Narita
Kiyohito
K
Yamamoto
Kimihiro
K
Komori
D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*
D000925:Anticoagulants