• Kenneth J Steier, Geeta Singh, Asmat Ullah, Jennifer Maneja, Rose Sanghee Ha, and Farhan Khan.
• Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554-1859, USA. ksteier@numc.edu
• J Am Osteopath Assoc. 2006 Jul 1;106(7):388-95.

ContextGuidelines on the use of prophylaxis in venous thromboembolism (VTE) are poorly implemented in clinical practice.ObjectiveTo evaluate the extent to which the American College of Chest Physicians (ACCP) 2001 guidelines on VTE prophylaxis are adhered to in clinical practice by determining whether patients admitted to a medical center with an objective diagnosis of VTE had received adequate prophylaxis.MethodsThe medical records of medical and surgery patients with an objective diagnosis of VTE were reviewed. Patients were classified as having either preventable or nonpreventable VTE according to indication for prophylaxis, VTE risk, and adequacy of prophylaxis if administered. Adequacy was determined by adherence to the ACCP 2001 guidelines.ResultsOf 44 patients, 17 (38.6%) had not received adequate prophylaxis and were classified as having potentially preventable VTE. Venous thromboembolism developed in the remaining 27 (61.4%) patients despite adequate prophylaxis. In general, adequate prophylaxis rates were lower among surgery patients compared with medical patients. Four (80%) of the very-high-risk surgery patients received inadequate prophylaxis. The most common VTE risk factor in both categories was immobility.ConclusionsAdherence to the ACCP guidelines is suboptimal, with a substantial proportion of patients with VTE receiving inadequate prophylaxis. The additional finding that the incidence of VTE is high despite adequate prophylaxis indicates that the guidelines may need to be reevaluated.

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