Improving VTE Management

The prevention of VTE is important to avoid the morbid and potentially lethal effects of DVT and PE, as well as to reduce the future risk of recurrent VTE, the chronic health and cost burden of post-thrombotic syndrome (PTS), and the risks of pulmonary hypertension.

There is strong scientific evidence in support of VTE prevention, demonstrating the efficacy of pharmaco-thromboprophylaxis in different patient groups. This evidence is effectively summarized in international guidelines on VTE prevention. Both the American College of Chest Physicians (ACCP)¹ and an International Consensus group² have published guidelines based on scientific published data that favour the use of pharmaco-thromboprophylaxis in at-risk groups, including both medical and surgical patients.

Registry data and studies of adherence to guideline recommendations continue to highlight the fact that the risk of VTE is underestimated, and that patients are still receiving sub-optimal or inappropriate prophylaxis.
 
The IMPROVE³ and DVT-FREE⁴ registries indicated that high numbers of hospitalized patients are at risk of VTE. From these patients at risk of VTE only approximately half of them received thromboprophylaxis.

A number of strategies are being used to aid and support better implementation of the guidelines. These include:

• electronic alert systems and risk-assessment models for identifying the patients at risk and the appropriate prophylaxis for them
• educational programmes for physicians and nurses such as the “DVT Safety Zone” programme
• country-specific guidelines produced in easy-to-read and -use formats
• development of hospital protocols for VTE prevention
• hospital accreditation schemes
• facilitating the commitment of health authorities to VTE prevention

There are plans, for example, to introduce a star system for UK hospitals adopting good VTE prevention practices, and in the USA many centres are encouraged by The Joint Commission (TJC) to adopt national standards for VTE prevention.
 
With such schemes and a concerted effort based on a foundation of clinical evidence and clear guidance for practice, the burden of preventable VTE can be tackled and reduced.

References

1. Geerts WH, Pineo GF, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126 Suppl 3:338S-400S.
2. Nicolaides AN, Breddin HK, et al. Prevention of venous thromboembolism. International Consensus Statement. Guidelines compiled in accordance with the scientific evidence. Int Angiol. 2001;20:1-37.
3. Tapson VF, Chong BH, et al. Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients. Chest. 2007;132:936-45.
4. Goldhaber SZ, Tapson VF, et al. A prospective registry of 5451 patients with ultrasound confirmed deep vein thrombosis. Am J Cardiol. 2004;93:259-62.