Venous thromboembolism is a topic that touches most hospital staff in some way. I decided to delve into the topic of DVT/PE to do a little research for myself in answering questions and at the same time hope to shed more light on this cause of 10% of hospital deaths that is very preventable.
Some of the risk factors for VTE include stasis, hypercoagulability and endothelial damage. Stasis includes age > 40, CHF, stroke, anesthesia, immobility, obesity and other conditions'. Hypercoagulability includes cancer, high estrogen, inflammatory bowel, nephrotic syndrome, sepsis, smoking and pregnancy. Surgery, prior VTE and trauma are other examples. It should be fairly obvious after thinking about risk factors that most patients in the hospital will have at least one risk factor for VTE.
A study in Lancet showed that out of around 70,000 patients in 358 hospitals, appropriate prophylaxis was administered in 58.5% of surgical patients and only 39.5 % of medical patients. (Cohen, Tapson, Bergmann, et al. Venous thromboembolism and risk and prophylaxis int he acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 2008; 371: 387-94.
Who is paying attention? The NQF "(National Quality Forum) is a not-for-profit, nonpartisan, membership-based organization that works to catalyze improvements in healthcare." The Joint Commission is also watching. We all know who TJC is right? TJC has their own core measures that hospitals are monitoring for VTE prophylaxis. Here are some of the standards released in the past few years with the last being a summary (though a bit on the long side).
- The Annals of Internal Medicine published an article (clinical guideline) a couple of years ago called Venous Thromboembolism Prophylaxis in Hopsitalized Patients: A Clinical Practice Guideline From the American College of Physicians.
- CHEST released their 2012 Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
- Here is the summary of the same from CHEST: Antithrombotic Therapy and Prevention of Thrombosis 9th Edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.
- AHRQ: National Guideline Clearinghouse Venous Thromboembolism Prophylaxis