Objectives: To identify and characterize cases of potentially preventable venous thromboembolism (VTE): cases for which thromboprophylaxis was indicated.

Objectives: To identify and characterize cases of potentially preventable venous thromboembolism (VTE): cases for which thromboprophylaxis was indicated, according to the American society of Chest Physicians (ACCP) consensus guidelines for VTE prevention, still was administered inadequately.

Design: A historical cohort research to examine all cases of difficult vein thrombosis and pulmonary embolism from 1996 to 1997 at a large teaching hospital. Of these, we determined the proportion that was potentially preventable. We examined the reasons for inadequacy of prophylaxis and the setting in which preventable VTE occurred

Results: Of 253 objectively diagnosed cases of VTE in 245 patients, 44 cases (174%) were considered potentially preventable. This give an account ofed two thirds of all VTE cases for which thromboprophylaxis had been indicated (n = 65) Of preventable cases, the in the greatest degree frequent reason for inadequacy of prophylaxis was omission of prophylaxis (477%) followed through inadequate duration of prophylaxis (227%) and by way of incorrect type of prophylaxis (205%) Surgical and medical indications for thromboprophylaxis that were frequent among preventable cases included nonorthopedic surgery admission to hospital for pneumonia, and shock with lower limb paralysis. Underlying risk factors for VTE that were frequent among preventable cases included latter immobility, active cancer, and obesity.

Conclusions: undivided of six cases of all VTE and couple of three cases of VTE for which thromboprophylaxis had been indicated could potentially have been debared had physicians followed the make acceptableed ACCP guidelines. Inadequacy of prophylaxis was most numerous often caused by omission of prophylaxis. Missed opportunities for prevention occurr greatest in number commonly in the settings of nonorthopedic surgery pneumonia, and stroke

clew words: guideline implementation; prevention; thromboprophylaxis; venous thromboembolism

Abbreviations: ACCP = American association of Chest Physicians; DVT = of great depth vein thrombosis; PE = pulmonary embolism; VTE = venous thromboembolism

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Venous thromboembolism (VTE) is a major cause of morbidity and mortality in hospitalized patients. It is estimated that > 250000 patients are hospitalized annually in the United States with VTE (1) and the overall undressed mortality rate from pulmonary embolism (PE) at 3 month has been reported to be as high as 174% (2) Given that knotty vein thrombosis (DVT) is ofttimes clinically silent and PE may be rapidly fatal, prevention is the most numerous effective strategy to reduce the lading of VTE and has been clearly shown to be cost-effective within a reduction in both fatal complications and treatment requirements. (3)

each 3 years since 1986, the American guild of Chest Physicians (ACCP) has published comprehensive guidelines for the prevention of VTE greatest in number recently published in January 2001 (4) The guidelines identify risk clusters of patients who should receive thromboprophylaxis, and they approve the type of prophylaxis that is principally appropriate for each risk cluster The recommendations are formulated by way of experts in the field after critical review of the published literature and are categorized onward the basis of the nerve of the supporting evidence. These evidence-based recommendations are generally considered to be the standard of care for DVT and for PE prevention. However, studies (256) recommend that, in practice, implementation of the guidelines may be inconsistent and inadequate.

In this application of mind we attempted to identify the obstacles that hinder the succes of VTE prevention at our institution by the agency of examining the rate of preventable VTE during a 1-year time period. Preventable VTE was defined as objectively diagnosed DVT or PE that occurr in a setting in which thromboprophylaxis was indicated however was either administered inadequately or not administered at all. The indications for thromboprophylaxis that were used in this subject of attention were outlined in the 1995 ACCP guidelines in succession VTE prevention, (7) according to the greatest in number recent version of the guidelines available at the time of this meditation Among preventable cases of VTE we examined the reasons for inadequacy of prophylaxis on comparing the prophylaxis regimens used with the prophylaxis regimens commited by the guidelines. In addition, we compared preventable VTE with nonpreventable VTE ie, VTE that occurr despite exact adherence to the guidelines, with heed to patient characteristics and the settings in which VTE occurred

MATERIALS AND METHODS

We actionsed a historical cohort study in which we performed a chart review forward all patients with objectively diagnosed DVT or PE who were admitted to the Sir Mortimer B Davis Jewish General Hospital in Montreal, a 637-bed McGill University teaching hospital, between October 1996 and October 1997 This 1-year period was chosen because (1) it allowed sufficient time for dissemination and implementation of the 1995 ACCP guidelines upon VTE prevention, (7) and (2) it preced the introduction of an crisis department-based outpatient DVT treatment program, for which recorded clinical information might have been les unbroken than for VTE patients admitted to hospital. Prior to its initiation, the Research Ethics Committee of the hospital approved the reflection protocol.

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