Context: Guidelines to prevent venous thromboembolism
(VTE) have been widely distributed and generally have been assumed to
be effective. Therefore, among hospitalized patients, the development
of VTE is thought to occur in the context of omitted prophylaxis.
Objectives: To describe hospitalized patients who develop
VTE and to determine whether they received antecedent prophylaxis.
Design: Case series.
Setting: Brigham and
Patients: Three hundred eighty-four
patients who developed in-hospital deep venous thrombosis or pulmonary
embolism or who developed VTE within 30 days of prior hospital
Main outcome measures: The relationship of
developing new-onset VTE to the use or omission of antecedent
Results: Of the 384
identified patients, 272 had deep venous thrombosis alone, 62 had
pulmonary embolism alone, and 50 had deep venous thrombosis and
pulmonary embolism. Most were medical service patients; fewer than one
fourth were general or orthopedic surgery patients. Overall, 52% had
received antecedent VTE prophylaxis. Thirteen deaths (3.4%) were
ascribed to pulmonary embolism, and prophylaxis was omitted in only 1
of those 13 patients.
Conclusions: Most deaths from
pulmonary embolism among patients hospitalized for other conditions
occurred in the setting of failed prophylaxis rather than omitted
prophylaxis. High-risk patients, especially medical service patients,
warrant intensive VTE prophylaxis and close follow-up to ensure