VTE prophylaxis: How well are guidelines being followed?

The American College of Chest Physicians (ACCP) has established guidelines for the prevention of venous thromboembolism (VTE); however, a recent study by Amin and associates documents a very low rate of adherence to these guidelines in acute-care hospitals in the United States. In fact, they found that about two thirds of at risk medical patients are not receiving appropriate VTE prophylaxis at the time of discharge.

Their analysis focused on at-risk medical patients and included data from 196,104 discharges from 227 hospitals. The patients were at least 40 years of age, were hospitalized for at least 6 days, and had no contraindications to anticoagulants. The overall rate of VTE prophylaxis was 61.8%; however, the rate of appropriate prophylaxis-prophylaxis in accordance with the ACCP guidelines-was only 33.9%.

Of the discharged patients who did not receive appropriate prophylaxis, 38.4% received no prophylaxis at all, 4.7% received only mechanical prophylaxis, 6.3% received inappropriate dosages, and 16.7% did not receive prophylaxis for the recommended duration.