Venous Thromboembolism (DVT and PE) Overview

Medical Prophylaxis
LMWH vs. UFH Meta-Analysis
VTE Prophylaxis Rates in Medical
Patients
Outcome
# Patients
analyzed
RR
95% CI
SOLUCIENT 01 (1)
26
DVT
4,421
0.68
0.52-0.88
DVT FREE 01-02 (2)
42
PE
Major bleeding
Minor Bleeding
4,231
4,497
3,538
0.57
0.77
0.61
0.25-1.34
0.50-1.20
0.34-1.10
HealthFacts 01-05 (3)
PREMIER 02 (4)
IMPROVE* 02-03 (5)
IMPROVE 02-06 (6)
15.3
29
39
54
Total bleeding
4,715
0.83
0.60-1.14
SOLUCIENT 04 (1)
33
Injection site hematoma
Mortality
2,002
4,881
0.47
1.16
0.36-0.62
0.85-1.59
PREMIER 05 (4)
37
ENDORSE* 06-07 (7)
40
0 10 20 30 40 50 60 70
percentage (%)
Wein L, et al. Arch Intern Med 2007;167:1476-86.
Why is Prophylaxis Underused in
At-Risk Medical Patients?
Potential Reasons
Clinicians unaware of the level of VTE risk
Not a ‘one specialty’ responsibility
Heterogeneous population
Perceived difficulties in risk assessment
Few studies of prophylaxis
8 th ACCP Conference
For every general hospital, we recommend
that a formal, active strategy that addresses
the prevention of VTE be developed (Grade
1A).
We recommend that the local
thromboprophylaxis strategy be in the form of
a written, institution-wide thromboprophylaxis
policy.
Gee WH, et al. CHEST 2001;119:132S-175S.
2008
Joint Commission on Accreditation of
Healthcare Organizations
Collaboration with NQF to develop standardized performance
measures for DVT prevention
The Joint Commission Benchmark states
– “DVT is one of the most common preventable causes of
deaths in hospitals”
– “Only 30% to 40% of patients who should be treated to prevent DVT
actually receive such treatment”
– “The use of proven and effective DVT prevention…methods
could save the lives of many patients”
NATIONAL QUALITY FORUM ENDORSES CONSENSUS
STANDARDS FOR QUALITY OF HOSPITAL CARE
Joint Commission Core Measures as of
Oct. 1, 2009
Venous Thromboembolism
VTE prophylaxis
Intensive Care Unit (ICU) VTE Prophylaxis
VTE Patients with Anticoagulation Overlap Therapy
VTE Patients Unfractionated Heparin (UFH)
Dosages/Platelet Count Monitoring by Protocol (or
Nomogram)
VTE Discharge Instructions
Incidence of Potentially Preventable VTE
Page 6
6