title: Disease burden and unmet needs for prevention of venous thromboembolism in medically ill patients in Europe show underutilisation of preventive therapies.
abstract: It was the aim of this review to assess the incidence of venous thromboembolism (VTE) and current practice patterns for VTE prophylaxis among medical patients with acute illness in Europe. A literature search was conducted on the epidemiology and prophylaxis practices of VTE prevention among adult patients treated in-hospital for major medical conditions. A total of 21 studies with European information published between 1999 and April 2010 were retrieved. Among patients hospitalised for an acute medical illness, the incidence of VTE varied between 3.65% (symptomatic only over 10.9 days) and 14.9% (asymptomatic and symptomatic over 14 days). While clinical guidelines recommend pharmacologic VTE prophylaxis for patients admitted to hospital with an acute medical illness who are bedridden, clear identification of specific risk groups who would benefit from VTE prophylaxis is lacking. In the majority of studies retrieved, prophylaxis was under-used among medical inpatients; 21% to 62% of all patients admitted to the hospital for acute medical illnesses did not receive VTE prophylaxis. Furthermore, among patients who did receive prophylaxis, a considerable proportion received medication that was not in accord with guidelines due to short duration, suboptimal dose, or inappropriate type of prophylaxis. In most cases, the duration of VTE prophylaxis did not exceed hospital stay, the mean duration of which varied between 5 and 11 days. In conclusion, despite demonstrated efficacy and established guidelines supporting VTE prophylaxis, utilisation rates and treatment duration remain suboptimal, leaving medical patients at continued risk for VTE. Improved guideline adherence and effective care delivery among the medically ill are stressed.
authors.affiliation: BioMedCom Consultants Inc., 1405 TransCanada Highway, Suite 310, Montreal, Quebec H9P2V9, Canada. hanane_khoury@biomedcom.org
authors.forename: Hanane
authors.initials: H
authors.lastname: Khoury
authors.forename: Sharon
authors.initials: S
authors.lastname: Welner
authors.forename: Maria
authors.initials: M
authors.lastname: Kubin
authors.forename: Kerstin
authors.initials: K
authors.lastname: Folkerts
authors.forename: Sylvia
authors.initials: S
authors.lastname: Haas
mesh_terms: D000208:Acute Disease; D000328:Adult; D058070:Asymptomatic Diseases; D005060:Europe; D019983:Guideline Adherence; D017048:Health Care Costs; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control