Prevention is paramount to current medical management, particularly when the evidence supporting preventative therapies is robust. One such “preventative therapy” focuses on strategies for inpatient prevention of venous thromboembolic disease in medically and surgically ill patients. Venous thromboembolism (VTE) is a significant sequela of inpatient hospitalization with estimated prevalence rates of approximately 25% in hospitalized medical patients,1
with as high as 60% of hospitalized postorthopaedic surgical patients2
not receiving prophylaxis. Developing VTE as an inpatient can increase morbidity by increasing the length of hospitalization, introducing new chronic medications, decreasing mobility and rehabilitation, and developing significant downstream effects, including pulmonary embolism. These rates can be dramatically reduced with pharmacologic prophylaxis.3
1. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004;126:338S–400S.
2. National Institute for Health and Clinical Excellence. Reducing the risk of venous thromboembolism (deep venous thrombosis and pulmonary embolism) in patients undergoing surgery. NICE Clinical Guidelines No.GC46. April 2007. Available at: http://www.nice.org.uk/
. Accessed July 7, 2008.
3. Dentali F, Douketis JD, Gianni M, et al. Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized patients. Ann Intern Med 2007;146:278–288.
4. Lyman GH, Khorana AA, Falanga A, et al., American Society of Clinical Oncology. American Society of Clinical Oncology Guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. J Clin Oncol 2007;25:5490–5505.
5. Antithrombotic and thrombolytic therapy, 8th Ed: ACCP. Chest 2008;133(suppl):67S–968S.
6. Cohen AT, Tapson VF, Bergmann JF, et al., ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008;371:387–394.
7. Tapson VF, Decousus H, Pini M, et al., IMPROVE Investigators. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the International Medical Prevention Registry on Venous Thromboembolism. Chest 2007;132:936–945.
8. Kucher N, Koo S, Quiroz R, et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 2005;352:969–977.
9. Baroletti S, Munz K, Sonis J, et al. Electronic alerts for hospitalized high-VTE risk patients not receiving prophylaxis: a cohort study. J Thromb Thrombolysis 2008;25:146–150.
10. Rocha AT, Paiva EF, Lichtenstein A, et al. Risk-assessment algorithm and recommendations for venous thromboembolism prophylaxis in medical patients. Vasc Health Risk Manag 2007;3:533–553.
11. Dexter PR, Perkins S, Overhage JM, et al. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med 2001;345:965–970.
12. Durieux P, Nizard R, Ravaud P, et al. A clinical decision support system for prevention of venous thromboembolism: effect on physician behavior. JAMA 2000;283:2816–2821.
13. Shedd GC, Franklin C, Schumacher AM, Green DE. Improving inpatient venous thromboembolism prophylaxis. South Med J. 2008;101:1209–1215.
14. Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon 2005;51:70–78.
15. Cohen AT, Agnelli G, Anderson FA, et al., VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb Haemost 2007;98:756–764.
16. Hess CT, Rook LJ. Understanding recent regulatory guidelines for hospital-acquired catheter-related urinary tract infections and pressure ulcers. Ostomy Wound Manage 2007;53:34–42.
17. Hospital-Acquired Conditions (Present on Admission Indicator). From Centers for Medicare and Medicaid Services. May 16, 2008. Available at: http://www.cms.hhs.gov/HospitalAcqCond/
. Accessed July 7, 2008.