Risk for thromboembolism in hospitalized patients is high; the rate of appropriate prophylaxis is far too low

A recent paper and an editorial in the Lancet discussed the high rate of complications from venous thromboembolism (VTE) in both surgical and medical hospitalized patients and the relatively low rate of VTE prophylaxis.  They note that pharmacological prophylaxis reduces the risk of pulmonary embolism in general surgical patients by 75% and by 57% in medical patients.  However a cross sectional survey of nearly 70,000 hospitalized patients in 32 countries revealed that though 66% of surgical patients and 40% of medical patients were eligible for VTE prophylaxis only 59% and 40% of the at risk patients received this potentially lifesaving therapy.  Data from United States Centers appeared better than the overall.  Of the at risk surgical patients 80% were receiving some sort of prophylaxis and 71% were receiving the American College of Chest Physicians recommended prophylaxis.  However only 64% of at risk medical patients were receiving any sort of prophylaxis.  From 1) Cohen AT et al: Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study); a multinational cross-sectional study.  Lancet 2008;371:381- 394 2) Ageno W, Dentali F: Prevention of in-hospital VTE: why can’t we do better? Lancet 2008;371:361-362

David S. Smith, M.D., Ph.D.