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8/17/2000

Preventive Therapy Underused in Surgical Patients

Katherine M. Bennett

Only two thirds of surgical patients at risk for venous thromboembolism (VTE) received first-rate prophylaxis, according to a pharmacist-led multicenter review of medical charts.

Mark A. Stratton, Pharm.D., and colleagues examined the records of 1,907 randomly selected surgical patients who had been disharged from 10 hospitals nationwide. The researchers, whose report appeared in the Feb. 14 issue of Archives of Internal Medicine, compared the regimens used to prevent VTE in these patients against recommendations from the American College of Chest Physicians consensus conference on antithrombotic therapy published the previous year, in 1995. Therapies supported by the most rigorously designed studies were defined by the conference as "grade A." 

Patients' receipt of grade A therapies varied significantly by the type of surgery, with highest use for total hip replacement, 84 percent, and lowest use for hip fracture repair, 45 percent. Contributing to this low rate among patients undergoing hip fracture repair, the researchers wrote, was the large proportion who received treatment with low-dose unfractionated heparin. Of the 694 patients who did not receive grade A prophylaxis, 204 did not receive any therapy. 

When discharged from the hospitals, only 50 percent of patients received some form of VTE prophylaxis. The researchers did not report whether VTE developed in the patients. 

Three of the 10 hospitals actually had in place methods, such as critical pathways, for encouraging VTE prophylaxis. The other seven hospitals had a physician or pharmacist involved in deciding on VTE prophylaxis. The researchers suggested that publication alone may be insufficient to incorporate recommendations from consensus guidelines into routine practice. 

To read the article, go to archinte.ama-assn.org/issues/v160n3/pdf/ioi81363.pdf (PDF).