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Original Research: VENOUS THROMBOEMBOLISM |

Venous Thromboembolism Prophylaxis in Acutely Ill Hospitalized Medical Patients*: Findings From the International Medical Prevention Registry on Venous Thromboembolism

Victor F. Tapson, MD, FCCP; Hervé Decousus, MD; Mario Pini, MD; Beng H. Chong, MD, PhD; James B. Froehlich, MD, MPH; Manuel Monreal, MD; Alex C. Spyropoulos, MD, FCCP; Geno J. Merli, MD; Rainer B. Zotz, MD; Jean-François Bergmann, MD; Ricardo Pavanello, MD; Alexander G.G. Turpie, MD; Mashio Nakamura, MD; Franco Piovella, MD; Ajay K. Kakkar, MD, PhD; Frederick A. Spencer, MD; Gordon FitzGerald, PhD; Frederick A. Anderson, Jr, PhD; for the IMPROVE Investigators
Author and Funding Information

*From the Duke University Medical Center (Dr. Tapson), Durham, NC; Institut National de la Santé et de la Recherche Médicale (Dr. Decousus), CIE3, Saint-Etienne, France; Ospedale di Fidenza Medicina Interna (Dr. Pini), Fidenza, Italy; Medicine Department (Dr. Chong) St. George Hospital, Kogarah, NSW, Australia; Vascular Medicine (Dr. Froehlich), University of Michigan Health System, Ann Arbor, MI; Servicio de Medicina Interna (Dr. Monreal), Hospital Germans Trias i Pujol, Badalona, Spain; Lovelace Medical Center (Dr. Spyropoulos), Clinical Thrombosis Center, Albuquerque, NM; Jefferson Antithrombotic Therapy Service (Dr. Merli), Division of Internal Medicine, Philadelphia, PA; Universitätsklinikum Düsseldorf (Dr. Zotz), Institut für Hämostaseologie und Transfusionsmedizin, Düsseldorf, Germany; Hôpital Lariboisiere Clinique Thérapeutique (Dr. Bergmann), Paris, France; Hospital do Coração Clínica Médica (Dr. Pavanello), São Paulo, Brazil; Hamilton Health Sciences General Hospital (Dr. Turpie), Hamilton, ON, Canada; Faculty of Medicine (Dr. Nakamura), First Department of Internal Medicine, Mie University, Tsu Mie, Japan; Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo (Dr. Piovella), Servizio Malattie Tromboemboliche, Pavia, Italy; Centre for Surgical Sciences (Dr. Kakkar), Barts and The London, Queen Mary School of Medicine, London, UK; Division of Cardiovascular Medicine (Dr. Spencer), Center for Outcomes Research, (Drs. FitzGerald and Anderson), University of Massachusetts Medical School, Worcester, MA.

Correspondence to: Victor F. Tapson, MD, FCCP, Professor of Medicine, Division of Pulmonary and Critical Care, Box 31175, Room 351 Bell Building, Duke University Medical Center, Durham, NC 27710; e-mail: tapso001@mc.duke.edu


*From the Duke University Medical Center (Dr. Tapson), Durham, NC; Institut National de la Santé et de la Recherche Médicale (Dr. Decousus), CIE3, Saint-Etienne, France; Ospedale di Fidenza Medicina Interna (Dr. Pini), Fidenza, Italy; Medicine Department (Dr. Chong) St. George Hospital, Kogarah, NSW, Australia; Vascular Medicine (Dr. Froehlich), University of Michigan Health System, Ann Arbor, MI; Servicio de Medicina Interna (Dr. Monreal), Hospital Germans Trias i Pujol, Badalona, Spain; Lovelace Medical Center (Dr. Spyropoulos), Clinical Thrombosis Center, Albuquerque, NM; Jefferson Antithrombotic Therapy Service (Dr. Merli), Division of Internal Medicine, Philadelphia, PA; Universitätsklinikum Düsseldorf (Dr. Zotz), Institut für Hämostaseologie und Transfusionsmedizin, Düsseldorf, Germany; Hôpital Lariboisiere Clinique Thérapeutique (Dr. Bergmann), Paris, France; Hospital do Coração Clínica Médica (Dr. Pavanello), São Paulo, Brazil; Hamilton Health Sciences General Hospital (Dr. Turpie), Hamilton, ON, Canada; Faculty of Medicine (Dr. Nakamura), First Department of Internal Medicine, Mie University, Tsu Mie, Japan; Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo (Dr. Piovella), Servizio Malattie Tromboemboliche, Pavia, Italy; Centre for Surgical Sciences (Dr. Kakkar), Barts and The London, Queen Mary School of Medicine, London, UK; Division of Cardiovascular Medicine (Dr. Spencer), Center for Outcomes Research, (Drs. FitzGerald and Anderson), University of Massachusetts Medical School, Worcester, MA.


Chest. 2007;132(3):936-945. doi:10.1378/chest.06-2993
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Background: Evidence-based guidelines recommend that acutely ill hospitalized medical patients who are at risk of venous thromboembolism (VTE) should receive prophylaxis. Our aim was to characterize the clinical practices for VTE prophylaxis in acutely ill hospitalized medical patients enrolled in the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE).

Methods: IMPROVE is an ongoing, multinational, observational study. Participating hospitals enroll the first 10 consecutive eligible acutely ill medical patients each month. Patient management is determined by the treating physicians. An analysis of data on VTE prophylaxis practices is presented.

Results: From July 2002 to September 30, 2006, 15,156 patients were enrolled from 52 hospitals in 12 countries, of whom 50% received in-hospital pharmacologic and/or mechanical VTE prophylaxis. In the United States and other participating countries, 52% and 43% of patients, respectively, should have received prophylaxis according to guideline recommendations from the American College of Chest Physicians (ACCP). Only approximately 60% of patients who either met the ACCP criteria for requiring prophylaxis or were eligible for enrollment in randomized clinical trials that have shown the benefits of pharmacologic prophylaxis actually received prophylaxis. Practices varied considerably. Intermittent pneumatic compression was the most common form of medical prophylaxis utilized in the United States, although it was used very rarely in other countries (22% vs 0.2%, respectively). Unfractionated heparin was the most frequent pharmacologic approach used in the United States (21% of patients), with low-molecular-weight heparin used most frequently in other participating countries (40%). There was also variable use of elastic stockings in the United States and other participating countries (3% vs 7%, respectively).

Conclusions: Our data suggest that physicians’ practices for providing VTE prophylaxis to acutely ill hospitalized medical patients are suboptimal and highlight the need for improved implementation of existing evidence-based guidelines in hospitals.

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