Prevention of venous thromboembolism: a key patient safety priority

Abstract

Summary. It is more than 50 years since the first publication of a study showing that symptomatic and fatal venous thromboembolism could be reduced with the use of thromboprophylaxis. Furthermore, it is 23 years since the first evidence-based guidelines recommended routine use of thromboprophylaxis for most hospitalized patients. However, despite the overwhelming evidence that thromboprophylaxis safely and inexpensively reduces thromboembolic complications associated with acute illness and surgery, there continue to be large gaps in the provision of this key patient safety intervention and even larger gaps in the provision of optimal thromboprophylaxis. The implementation of quality improvement strategies, both at the national level and in local hospitals, are able to increase awareness of thromboembolic risks, to increase adherence to thromboprophylaxis guidelines, and to decrease both clinically important thromboembolic events and hospital costs. Therefore, the objective is for every hospitalized patient to receive appropriate thromboprophylaxis based on their thromboembolic and bleeding risks.

Prevention of venous thromboembolism in patients admitted to Australian hospitals: summary of National Health and Medical Research Council clinical practice guideline

“…5,37 Almost 60% of VTE events in western communities are potentially preventable because they are provoked by surgery or a medical illness and develop during or soon after admission to hospital. 2,15 The key to reducing the morbidity and mortality of VTE is effective prophylaxis, because death from embolism is often rapid and most large emboli discovered at autopsy were clinically unsuspected during life.…”

“…3 These statistics make VTE a major patient safety issue for hospitals. [5][6][7] As prophylaxis is known to reduce the rate of VTE, [8][9][10] the National Institute of Clinical Studies, an institute of the National Health and Medical Research Council (NHMRC), identified the need to address the underuse of preventive measures for VTE in Australian hospitals as a clinical priority. 11 This paper presents the latest recommendations contained within the NHMRC's Clinical Practice Guideline for the prevention of VTE in patients admitted to Australian hospitals, as one part of the strategy to increase appropriate VTE prophylaxis.…”

“…15,16 Surveys of clinical practice in hospitals consistently find that VTE prophylaxis remains poorly implemented. 5,17 A good example is a recent large and multinational, prospective, cross-sectional survey of VTE risk and prophylaxis that included Australian hospitals. 18 The survey examined inpatient charts from a randomly selected sample of hospitals to estimate VTE risk, bleeding risk and the use of VTE prophylaxis.…”

Risk factors for in-hospital venous thromboembolism in children: a case-control study employing diagnostic validation

“…Additionally, a systematic review of the pediatric literature has demonstrated that at least 20% of children with limb DVT develop post-thrombotic syndrome (PTS), a syndrome of chronic venous insufficiency often associated with limitation in age-appropriate physical activities that are critical to normal growth and development. 7 Recommendations for prevention of hospital-acquired VTE in adults are well established 8 and have been informed by evidence from randomized controlled clinical trials. In pediatrics, such recommendations and data are largely lacking, historically attributable to the rarity of VTE in this population.…”

Thrombotic risk assessment questionary helps increase the use of thromboprophylaxis for patients with pelvic and acetabular fractures

“…Thromboembolism prophylaxis has been identified as an algorism of primary importance to improve patient safety in practice 12. However, there is still considerable underutilization of appropriate pharmacologic or mechanical prophylaxis across a broad range of patients with known DVT risk 1314…”