Prevention of Venous Thromboembolism

Pharmacological prophylaxis should form the foundation for any prophylaxis program among hospitalised patients. For those with bleeding problems or whose risks of bleeding make this approach risky, mechanical prophylaxis should be utilised with graduated compression stockings, intermittent pneumatic compression devices, or both. For patients at very high risk of venous thromboembolism (VTE), combined pharmacological and mechanical prophylaxis should be ordered. Failure to utilise VTE prophylaxis remains a problem in high-risk general medical and subspecialty medical patients. As part of a multifaceted approach, hospitals with adequate Information Systems should consider implementation of electronic alerts to increase deep vein thrombosis (DVT) awareness, increase use of prophylaxis, and decrease rates of DVT and pulmonary embolism. The same strategy can be instituted without any specialised computer systems, as long as a willing physician or nurse reviewer can be recruited. Within a few years, the voluntary aspects of ordering VTE prophylaxis will disappear, as regulatory authorities and insurers demand that VTE prevention becomes obligatory.