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Prevention of Venous Thromboembolism
Adherence to the 1995 American College of Chest Physicians Consensus Guidelines for Surgical Patients
Mark A. Stratton, PharmD;
Fredrick A. Anderson, PhD;
Henry I. Bussey, PharmD;
Joseph Caprini, MD;
Anthony Comerota, MD;
Stuart T. Haines, PharmD;
David W. Hawkins, PharmD;
Mary Beth O'Connell, PharmD;
Richard C. Smith, PharmD;
Kathleen A. Stringer, PharmD
Arch Intern Med. 2000;160:334-340.
Background The American College of Chest Physicians addressed the dilemma of identifying optimal therapy for venous thromboembolism (VTE) prophylaxis and published their Fourth Consensus Conference on Antithrombotic Therapy in 1995, with recommendations for prophylactic therapy. Despite these recommendations, appropriate VTE prophylactic therapy is underused.
Objectives To examine routine practices in the prevention of VTE in high-risk surgical patients and to determine the extent of adoption of grade A prophylactic therapies as recommended by the American College of Chest Physicians.
Methods Retrospective medical record review in 10 teaching or community-based hospitals located in the United States. Medical charts of 1907 patients were randomly selected for review from the population of patients who underwent high-risk major abdominal surgery, total hip replacement, hip fracture repair, or total knee replacement between January 1, 1996, and February 28, 1997.
Results Of 1907 patients, VTE prophylaxis was used in 89.3%; use was 93.7% in each of the 3 orthopedic surgery groups and 75.2% in the high-risk major abdominal surgery group. The percentage of patients receiving grade A therapy was highest in the hip replacement group (84.3%) vs the other groups (knee replacement, 75.9%; hip fracture repair, 45.2%; abdominal surgery, 50.3%).
Conclusions The use of grade A prophylaxis was related to the type of surgery, with the highest use seen in total hip replacement and the lowest in hip fracture repair. One in 4 patients who underwent high-risk major abdominal surgeries failed to receive any form of VTE prophylaxis. Publication of consensus statements alone may be insufficient to ensure the incorporation of important new clinical information into routine practice.
From the College of Pharmacy, University of Houston, and Hermann Hospital, Houston, Tex (Dr Stratton); Center for Outcomes Research, Department of Surgery, University of Massachusetts Medical Center, Worcester (Dr Anderson); Anticoagulation Clinics of North America, San Antonio, Tex (Dr Bussey); Department of Surgery, Evanston Hospital, and Northwestern University Medical School, Evanston, Ill (Dr Caprini); Department of Surgery, Temple University School of Medicine, Philadelphia, Pa (Dr Comerota); University of Maryland Medical Center and School of Pharmacy, Baltimore (Dr Haines); University Hospital and College of Pharmacy, University of Georgia, Augusta (Dr Hawkins); College of Pharmacy, University of Minnesota, and Hennepin County Medical Center, Minneapolis (Dr O'Connell); Department of Pharmacy, Green Hospital of the Scripps Clinic, La Jolla, Calif (Dr Smith); and University Hospital and School of Pharmacy, Unversity of Colorado, Denver (Dr Stringer).
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