The Pharmaceutical Journal
Vol 280 No 7488 p145
9 February 2008

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Adherence to thromboembolism guidance poor

Over half of hospital inpatients are at risk of venous thromboembolism (VTE) but rates of appropriate prophylaxis are low, according to a study in The Lancet involving 358 hospitals across 32 countries, including the UK.

The study aimed to assess the number of patients at risk of VTE in hospitals and to determine the proportion of these who received prophylaxis as recommended by the 2004 American College of Chest Physicians evidence-based consensus guidelines.

Patients aged 40 years or over admitted to a medical ward and those aged 18 years or over admitted to a surgical ward were assessed for risk of VTE. Researchers found that 51.8 per cent of patients were judged to be at risk (across country range 35.6–72.6), including 64.4 per cent of surgical and 41.5 per cent of medical patients

Recommended prophylaxis was administered to 58.5 per cent of at-risk surgical patients (0.2–92.1) compared with 39.5 per cent of at-risk medical patients (1–70.4).

In the UK, the proportion of at-risk medical patients who received ACCP-recommended prophylaxis was 37 per cent; 55 per cent did not receive any prophylaxis. Countries with the highest use of ACCP-recommended prophylaxis were Germany (70 per cent), Spain and Colombia (both 64 per cent).

For at-risk surgical patients, 74 per cent of UK patients received the ACCP-recommended prophylaxis and 19 per cent received no prophylaxis. Again, Germany had the highest rate of ACCP-recommended prophylaxis (92 per cent), followed by Hungary (87 per cent).

“Hospital-wide strategies to assess patients’ VTE risk should be implemented, together with measures that ensure that at-risk patients receive appropriate VTE prophylaxis,” the researchers conclude (2008;371:387).

In an accompanying editorial (ibid, p361), Walter Ageno of the University of Insubria, Italy, suggests that prophylaxis failure is due to ongoing disagreement about VTE risk among practising clinicians.