Guidelines and Performance Measures for the Prevention and Treatment of Venous Thromboembolism

BACKGROUND: Venous thromboembolism (VTE) is a common and often preventable cause of morbidity and mortality in the United States, with a widespread economic impact. OBJECTIVES: To describe the prevalence, morbidity, mortality, and risk factors associated with VTE; adherence rates to evidence-based guidelines for VTE prophylaxis and treatment; efforts to raise awareness to address the VTE problem, including strategies to promote VTE prophylaxis; and the optimal treatment of VTE. SUMMARY: An increased risk for VTE may be present in the early post-discharge period after brief hospitalization for medical and surgical patients. Adequate prophylaxis is the key to preventing VTE, recurrent VTE, post-thrombotic syndrome, and VTE-related death. Evaluation of clinical results indicates that there is considerable room for improvement in VTE prophylaxis use in hospitalized surgical and medical patients and in adherence to guidelines for VTE treatment. The heterogeneity of the patient population at risk for VTE is among the possible reasons for failure to institute pharmacologic or mechanical prophylaxis. National consensus standards for VTE prevention and treatment are applicable from hospitals to home care. Combinations of strategies are more effective than a single strategy in reducing VTE rates. In patients with VTE, the use of low molecular-weight heparin facilitates early hospital discharge and outpatient treatment. Opportunities to minimize the hospital length of stay and costs by discharging patients with VTE while they are receiving overlapping parenteral and oral anticoagulation therapy are often missed. CONCLUSIONS: Pharmacists efforts to increase VTE awareness, ensure VTE prophylaxis, and recommend appropriate VTE treatment can have a favorable clinical and economic impact.