Prophylaxis for Venous Thromboembolism: A Great Global Divide between Expert Guidelines and Clinical Practice?

Behnood Bikdeli; Babak Sharif-Kashani

doi:10.1055/s-0032-1301412

Seminars in Thrombosis and Hemostasis, Table of Contents

Semin Thromb Hemost 2012; 38(02): 144-155
DOI: 10.1055/s-0032-1301412

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prophylaxis for Venous Thromboembolism: A Great Global Divide between Expert Guidelines and Clinical Practice?

Behnood Bikdeli

¹Cardiovascular Department, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University MC, Tehran, Iran

²Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut

³Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut

,

Babak Sharif-Kashani

¹Cardiovascular Department, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University MC, Tehran, Iran

⁴Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University MC, Tehran, Iran

› Author Affiliations

Abstract

Our understanding of development and prevention of venous thromboembolism (VTE) has improved dramatically since Virchow described the triad of stasis, hypercoagulability, and endothelial dysfunction during the mid-1800s. A full arsenal of effective pharmacological and mechanical methods can help prevent VTE and many professional organizations have provided extensive evidence-based statements for VTE prophylaxis. Disappointingly, however, VTE has remained the major preventable cause of hospital death. Adherence rate to clinical guidelines is undesirably low. Many real-world patients have also been excluded from VTE prevention trials and hence practice guidelines recommendations. The comprehensive and repetitious formats of many available guidelines also limit their readability and applicability by nonthrombosis specialists. Moreover, some patients suffer from VTE despite complying with the contemporary prophylaxis regimens. Besides, significant heterogeneity exists in thromboprophylaxis practice and pitfalls between different countries. Last but not the least; although many at-risk patients are underprophylaxed, there is evidence to suggest that overprophylaxis (i.e., prescription of thromboprophylaxis in low-risk patients) comprises another important problem. We review the thromboprophylaxis practice and pitfalls around the world and provide recommendations on how the major obstacles can be overcome.

Keywords

venous thromboembolism - prevention - prophylaxis - guidelines adherence

Full Text

References

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