SAN DIEGO—Prophylaxis for deep vein thrombosis in hospitalized, acutely ill patients is clearly underused in the United States and Europe, results from a large international trial suggest.
“Despite the [American College of Chest Physicians] consensus guideline recommendations of 2001 and 2002 and evidence from clinical studies showing the benefits of DVT prophylaxis in acutely ill medical patients, only 44% received in-hospital prophylaxis,” Victor F. Tapson, M.D., reported in a poster session at the annual meeting of the American Society of Hematology. “I was a bit surprised at how low the rates actually were.”
The findings are part of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE).
Funded by an unrestricted grant from Aventis Pharmaceuticals Inc., the purpose of the multicenter registry is to assess routine clinical practices for providing hospitalized, acutely ill patients with venous thromboembolism prophylaxis and to test predictive models of the relationship between patient characteristics, prophylaxis use, and key clinical end points.
For the trial, patients aged 18 years and older who were hospitalized for at least 3 days were enrolled consecutively. Data were recorded at discharge and 3 months after discharge.
Dr. Tapson reported on 4,315 patients from 37 hospitals in 11 countries who were enrolled between January 1, 2002 and June 30, 2004. Half were female and the mean age was 69 years.
Less than half of the patients (44%) received in-hospital DVT prophylaxis, said Dr. Tapson, of Duke University Medical Center, Durham, N.C.
Low-molecular-weight heparin and unfractionated heparin were used most often. Low-molecular-weight heparin regimens were usually given once daily.
Unfractionated heparin regimens varied. Outside of the United States, most regimens (85%) were given every 12 hours. In the United States, a similar number of patients received unfractionated heparin every 12 hours (55%) or every 8 hours (40%).
Aspirin was given as DVT prophylaxis to 7% of patients in the United States and to 3% of patients in other countries.
“Unfractionated heparin is used more for medical patient prophylaxis than low-molecular-weight heparin in the United States, while the reverse is true in Europe and certain other parts of the world,” Dr. Tapson said in an interview.
“Low-molecular-weight heparin has considerable advantages, including once-daily injection and, for example, a lower risk of heparin-induced thrombocytopenia. This is very relevant to the primary care physician, particularly those that do inpatient work. They need to consider prophylaxis for every medical patient admitted, as most need it,” he added.
As for mechanical methods of DVT prophylaxis, clinicians in the United States used pneumatic compression more often, compared with clinicians in other countries (19% vs. 0.3%). In contrast, clinicians in other countries used elastic stockings more often, compared with those in the United States (8% vs. 2%).