Prophylaxis for venous thromboembolism in acutely ill, hospitalized medical patients often fails to meet evidence-based guidelines, according to findings from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE). Prophylaxis for venous thromboembolism in acutely ill, hospitalized medical patients often fails to meet evidence-based guidelines, according to findings from the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE).

Prophylaxis for nonsurgical patients is not used often enough "in spite of solid data showing that they are at risk," Dr. Victor F. Tapson from Duke University Medical Center, Durham, North Carolina told Reuters Health. "We already know prophylaxis works for them."

Dr. Tapson and colleagues used data from the IMPROVE registry to evaluate current physician practices for providing venous thromboembolism prophylaxis. Between July 2002 and September 2006, data from 52 hospitals in 12 countries were collected for more than 15,000 acutely ill, hospitalized medical patients who met the study criteria. Their findings are published in the September issue of Chest.

Only 52 per cent of patients in the United States and 43 per cent of patients in other countries met the current American College of Chest Physicians guidelines as medical patients who should receive prophylaxis, the authors report, but only 61 per cent of these patients had received some form of prophylaxis.

One third of the patients in the US and 47 per cent of patients in other countries received venous thromboembolism prophylaxis with low molecular weight heparin or unfractionated heparin, the report indicates.

Intermittent pneumatic compression and elastic stockings were used in only a small percentage of patients, the investigators say.

The median duration of venous thromboembolism prophylaxis was five days in the US and seven days in other countries.

"There is clearly room for improving physicians' practices through the implementation of current evidence-based guidelines in hospitals," the researchers conclude.

"Pulmonary embolism may kill as many as 300,000 people in the US every year," Dr. Tapson said. "Many of these are preventable."

"Education is key, but so far has not solved the problem," he added.

Dr. Tapson is part of a task force that plans to publish hospital performance measures that he hopes will be available by 2008. This may make an impact if hospital credentialing is based on such measures, he added.