Referring Physicians >>
December 2011 Vascular Newsletter >>
Preventing Venous Thromboembolism (VTE) in Hospitalized Patients
Venous thromboembolism (VTE), defined as deep venous thrombosis (DVT), pulmonary embolism (PE), or both, is one of the leading causes of preventable in-hospital mortality. Learn how hospitals can prevent VTEs by implementing evidence-based guidelines for risk assessment and prophylaxis.
Without appropriate prophylaxis, most hospitalized patients are risk for VTE. The degree of VTE risk depends primarily on the reason for hospitalization, with the highest risks for (1):
Types of Prophylaxis
Nonpharmacologic VTE prophylaxis options include:
Pharmacologic VTE prophylaxis options include:
Risk Assessment and Prophylaxis Guidelines
In 2008, the American College of Chest Physicians (AACP) issued updated, evidence-based clinical practice guidelines for VTE prevention in surgical patients (2). These guidelines, summarized below, are based on the primary reason for hospitalization, though patient-specific factors are also considered.
Studies have shown that LDUH and LMWH are equally effective for patients undergoing general surgery, gynecologic surgery, urologic surgery, or neurosurgery. LMWH is superior for patients undergoing orthopedic surgery, or who have spinal cord or traumatic injury (3).
Fondaparinux is indicated for patients undergoing hip fracture surgery, hip or knee replacement, or abdominal surgery who are also at risk for thromboembolic complications.
Patients who have a high risk of bleeding should receive mechanical prophylaxis (GCS and/or IPC) until the bleeding risk decreases, and then receive pharmacologic prophylaxis.
Numerous national organizations—including the AACP, the Agency for Healthcare Research and Quality (AHRQ), the National Quality Forum (NQF), the Surgical Care Improvement Project (SCIP), and the Joint Commission (TJC)—have all recommended that institutions implement formal, active strategies for addressing VTE prevention, plus develop written, evidence-based policies for thromboprophylaxis.
In 2009, a multidisciplinary task force at UW Hospital and Clinics (UWHC), began implementing a five-point plan to accomplish this. The plan:
The results? From 2008 to 2011, prophylaxis use at UWHC improved and the overall rate of postoperative VTE at decreased by 66%. In addition, the program reduced hospital costs by approximately $2 million in 2009 and 2010.
For more information about VTE prevention efforts at UWHC, visit us here.