Venous Thromboembolism Prophylaxis in Acutely Ill Hospitalized Medical Patients: Findings From the International Medical Prevention Registry on Venous Thromboembolism

摘要

Background: Evidence-based guidelines recommend that acutely ill hospitalized medical patientsnwho are at risk of venous thromboembolism (VTE) should receive prophylaxis. Our aim was toncharacterize the clinical practices for VTE prophylaxis in acutely ill hospitalized medical patientsnenrolled in the International Medical Prevention Registry on Venous Thromboembolism (IM-nPROVE).nMethods: IMPROVE is an ongoing, multinational, observational study. Participating hospitalsnenroll the first 10 consecutive eligible acutely ill medical patients each month. Patient manage-nment is determined by the treating physicians. An analysis of data on VTE prophylaxis practicesnis presented.nResults: From July 2002 to September 30, 2006, 15,156 patients were enrolled from 52 hospitalsnin 12 countries, of whom 50% received in-hospital pharmacologic and/or mechanical VTEnprophylaxis. In the United States and other participating countries, 52% and 43% of patients,nrespectively, should have received prophylaxis according to guideline recommendations from thenAmerican College of Chest Physicians (ACCP). Only approximately 60% of patients who eithernmet the ACCP criteria for requiring prophylaxis or were eligible for enrollment in randomizednclinical trials that have shown the benefits of pharmacologic prophylaxis actually receivednprophylaxis. Practices varied considerably. Intermittent pneumatic compression was the mostncommon form of medical prophylaxis utilized in the United States, although it was used verynrarely in other countries (22% vs 0.2%, respectively). Unfractionated heparin was the mostnfrequent pharmacologic approach used in the United States (21% of patients), with low-nmolecular-weight heparin used most frequently in other participating countries (40%). There wasnalso variable use of elastic stockings in the United States and other participating countries (3% vsn7%, respectively).nConclusions: Our data suggest that physicians’ practices for providing VTE prophylaxis to acutelynill hospitalized medical patients are suboptimal and highlight the need for improved implemen-ntation of existing evidence-based guidelines in hospitals.