Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018 Apr 24;4(4):CD008201.
doi: 10.1002/14651858.CD008201.pub3.

Interventions for implementation of thromboprophylaxis in hospitalized patients at risk for venous thromboembolism

Susan R Kahn  1 , David R Morrison, Gisèle Diendéré, Alexandre Piché, Kristian B Filion, Adi J Klil-Drori, James D Douketis, Jessica Emed, André Roussin, Vicky Tagalakis, Martin Morris, William Geerts
Affiliations
Meta-Analysis

Interventions for implementation of thromboprophylaxis in hospitalized patients at risk for venous thromboembolism

Susan R Kahn et al. Cochrane Database Syst Rev. .

Abstract

Background: Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospitalized patients. While numerous randomized controlled trials (RCTs) have shown that the appropriate use of thromboprophylaxis in hospitalized patients at risk for VTE is safe, effective, and cost-effective, thromboprophylaxis remains underused or inappropriately used. Our previous review suggested that system-wide interventions, such as education, alerts, and multifaceted interventions were more effective at improving the prescribing of thromboprophylaxis than relying on individual providers' behaviors. However, 47 of the 55 included studies in our previous review were observational in design. Thus, an update to our systematic review, focused on the higher level of evidence of RCTs only, was warranted.

Objectives: To assess the effects of system-wide interventions designed to increase the implementation of thromboprophylaxis and decrease the incidence of VTE in hospitalized adult medical and surgical patients at risk for VTE, focusing on RCTs only.

Search methods: Our research librarian conducted a systematic literature search of MEDLINE Ovid, and subsequently translated it to CENTRAL, PubMed, Embase Ovid, BIOSIS Previews Ovid, CINAHL, Web of Science, the Database of Abstracts of Reviews of Effects (DARE; in the Cochrane Library), NHS Economic Evaluation Database (EED; in the Cochrane Library), LILACS, and clinicaltrials.gov from inception to 7 January 2017. We also screened reference lists of relevant review articles. We identified 12,920 potentially relevant records.

Selection criteria: We included all types of RCTs, with random or quasi-random methods of allocation of interventions, which either randomized individuals (e.g. parallel group, cross-over, or factorial design RCTs), or groups of individuals (cluster RCTs (CRTs)), which aimed to increase the use of prophylaxis or appropriate prophylaxis, or decrease the occurrence of VTE in hospitalized adult patients. We excluded observational studies, studies in which the intervention was simply distribution of published guidelines, and studies whose interventions were not clearly described. Studies could be in any language.

Data collection and analysis: We collected data on the following outcomes: the number of participants who received prophylaxis or appropriate prophylaxis (as defined by study authors), the occurrence of any VTE (symptomatic or asymptomatic), mortality, and safety outcomes, such as bleeding. We categorized the interventions into alerts (computer or human alerts), multifaceted interventions (combination of interventions that could include an alert component), educational interventions (e.g. grand rounds, courses), and preprinted orders (written predefined orders completed by the physician on paper or electronically). We meta-analyzed data across RCTs using a random-effects model. For CRTs, we pooled effect estimates (risk difference (RD) and risk ratio (RR), with 95% confidence interval (CI), adjusted for clustering, when possible. We pooled results if three or more trials were available for a particular intervention. We assessed the certainty of the evidence according to the GRADE approach.

Main results: From the 12,920 records identified by our search, we included 13 RCTs (N = 35,997 participants) in our qualitative analysis and 11 RCTs (N = 33,207 participants) in our meta-analyses.

Primary outcome: Alerts were associated with an increase in the proportion of participants who received prophylaxis (RD 21%, 95% CI 15% to 27%; three studies; 5057 participants; I² = 75%; low-certainty evidence). The substantial statistical heterogeneity may be in part explained by patient types, type of hospital, and type of alert. Subgroup analyses were not feasible due to the small number of studies included in the meta-analysis.Multifaceted interventions were associated with a small increase in the proportion of participants who received prophylaxis (cluster-adjusted RD 4%, 95% CI 2% to 6%; five studies; 9198 participants; I² = 0%; moderate-certainty evidence). Multifaceted interventions with an alert component were found to be more effective than multifaceted interventions that did not include an alert, although there were not enough studies to conduct a pooled analysis.

Secondary outcomes: Alerts were associated with an increase in the proportion of participants who received appropriate prophylaxis (RD 16%, 95% CI 12% to 20%; three studies; 1820 participants; I² = 0; moderate-certainty evidence). Alerts were also associated with a reduction in the rate of symptomatic VTE at three months (RR 64%, 95% CI 47% to 86%; three studies; 5353 participants; I² = 15%; low-certainty evidence). Computer alerts were associated with a reduction in the rate of symptomatic VTE, although there were not enough studies to pool computer alerts and human alerts results separately.

Authors' conclusions: We reviewed RCTs that implemented a variety of system-wide strategies aimed at improving thromboprophylaxis in hospitalized patients. We found increased prescription of prophylaxis associated with alerts and multifaceted interventions, and increased prescription of appropriate prophylaxis associated with alerts. While multifaceted interventions were found to be less effective than alerts, a multifaceted intervention with an alert was more effective than one without an alert. Alerts, particularly computer alerts, were associated with a reduction in symptomatic VTE at three months, although there were not enough studies to pool computer alerts and human alerts results separately.Our analysis was underpowered to assess the effect on mortality and safety outcomes, such as bleeding.The incomplete reporting of relevant study design features did not allow complete assessment of the certainty of the evidence. However, the certainty of the evidence for improvement in outcomes was judged to be better than for our previous review (low- to moderate-certainty evidence, compared to very low-certainty evidence for most outcomes). The results of our updated review will help physicians, hospital administrators, and policy makers make practical decisions about adopting specific system-wide measures to improve prescription of thromboprophylaxis, and ultimately prevent VTE in hospitalized patients.

PubMed Disclaimer

Conflict of interest statement

The authors of this review did not receive any funding to undertake this review other than the peer‐reviewed grant noted above. The authors report the following declarations of interest:

SK has received grant support from public granting agencies (CIHR) for research on the treatment of venous thrombosis. She participated in industry‐sponsored advisory board meetings (Boehringer‐Ingelheim, Servier Canada, one meeting for each entity), on the treatment of venous thrombosis and provided expert testimony for the Canadian Medical Protective Association. SK also reports that Sanofi Aventis has partnered with her institution to help create a center of excellence in thrombosis and anticoagulation. DM: none known GD: none known AP: none known KBF: none known AJK: AJK's institution has received funds from the Young Investigator Award from the American Society of Clinical Oncology Conquer Cancer Foundation. AJK reports receiving payments from Bristol Myers Squibb for lectures. JD: JD reports receiving funds from board memberships of Bayer, Boehringer‐Ingelheim, Bristol‐Myers‐Squibb, Daiichi‐Sankyo, Pfizer, and Sanofi; consultancy fees from Actelion, Janssen Research and Development; funds for speaking at educational activities; royalties from the Merck Manual, Up‐to‐Date; JD's institution has received a grant from Boehringer‐Ingelheim. JE: JE received an honorarium for participation in a single meeting (focus group) with LEO Pharma for work unrelated to the submitted review. AR: AR reports board membership and consultancy activities for BMS, BI, Pfizer, and Bayer, and received payment for lectures from BMS, BI, Bayer, and Pfizer not related to this review. AR also reports that his institution has received a CIHR grant for AIDS vascular research, and payment for development of educational presentations from BI, Bayer, BMS, and Pfizer for the preparation of university‐accredited symposiums and slide kits. VT: VT has received, and currently holds grant support from the CIHR for research in venous thrombosis; has engaged in lectures sponsored by companies that manufacture anticoagulants (Leo Pharma, Bristol Myer Squibb, and Pfizer); has received a grant from a manufacturer of an anticoagulant (Sanofi Aventis). MM: reports receiving funds from American Academy of Clinical Toxicology for creation of search strategies for systematic reviews, and from International Team for Implantology for peer reviewing of search strategy. WG: WG reports board membership (Canadian Patient Safety Institute (Safer Health Care Now) National lead for venous thromboembolism prevention), consultancy (Bayer Healthcare, Pfizer, Sanofi) and payment for lectures (Bayer Healthcare, Leo Pharma, Sanofi) and development of educational presentations (Bayer Healthcare, Leo Pharma). Other support has been received by his institution from Sanofi for clinical and quality of care outreach programs. WG reports that these relationships in no way impact on his involvement with this Cochrane review.

Figures

1
1
Study flow diagram.
2
2
Summary of risk of bias: review authors’ judgements about each 'Risk of bias' item presented as percentages across all included studies
3
3
Summary of risk of bias: review authors’ judgements about each 'Risk of bias' item for each included study
4
4
Funnel plot of comparison: 1 Alerts versus standard care, outcome: 1.1 Received prophylaxis.
5
5
Funnel plot of comparison: 1 Alerts versus standard care, outcome: 1.2 Received appropriate prophylaxis.
6
6
Funnel plot of comparison: 1 Alerts versus standard care, outcome: 1.3 Symptomatic VTE.
7
7
Funnel plot of comparison: 2 Multifaceted interventions versus standard care or another intervention, outcome: 2.1 Received prophylaxis (unadjusted).
8
8
Funnel plot of comparison: 2 Multifaceted interventions versus standard care or another intervention, outcome: 2.2 Received prophylaxis (adjusted).
1.1
1.1. Analysis
Comparison 1 Alerts versus standard care, Outcome 1 Received prophylaxis.
1.2
1.2. Analysis
Comparison 1 Alerts versus standard care, Outcome 2 Received appropriate prophylaxis.
1.3
1.3. Analysis
Comparison 1 Alerts versus standard care, Outcome 3 Symptomatic VTE.
2.1
2.1. Analysis
Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 1 Received prophylaxis (unadjusted).
2.2
2.2. Analysis
Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 2 Received prophylaxis (adjusted).
2.3
2.3. Analysis
Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 3 Received prophylaxis (adjusted) sensitivity analysis: applied lowest ICC from other trials.
2.4
2.4. Analysis
Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 4 Received prophylaxis (adjusted) sensitivity analysis: applied mean ICC from other trials.
2.5
2.5. Analysis
Comparison 2 Multifaceted interventions versus standard care or another intervention, Outcome 5 Received prophylaxis (adjusted) sensitivity analysis: applied highest ICC from trials.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Anderson 1994 {published data only}
    1. Anderson FA Jr, Wheeler HB, Goldberg RJ, Hosmer DW, Forcier A, Patwardhan NA. Changing clinical practice. Prospective study of the impact of continuing medical education and quality assurance programs on use of prophylaxis for venous thromboembolism. Archives of Internal Medicine 1994;154(6):669‐77. [PMID: 8129501] - PubMed
Cavalcanti 2016 {published data only}
    1. Cavalcanti AB, Bozza FA, Machado FR, Salluh JI, Campagnucci VP, Vendramim P, et al. Effect of a quality improvement intervention with daily round checklists, goal setting, and clinician prompting on mortality of critically ill patients: a randomized clinical trial. JAMA 2016;315(14):1480‐90. [DOI: 10.1001/jama.2016.3463] - DOI - PubMed
Chapman 2011 {published data only (unpublished sought but not used)}
    1. Chapman NH, Lassere MN, Clarke M, Chong BH. Guidelines for venous thromboembolism (VTE) prevention in hospitalised medical patients: a validation study pilot. Journal of Thrombosis and Haemostasis 2011;9(2):654. [Available from dx.doi.org/10.1111/j.1538‐7836.2011.04380_3.x (accessed 17 July 2017)]
Dexter 2001 {published and unpublished data}
    1. Dexter PR, Perkins S, Overhage JM, Maharry K, Kohler RB, McDonald CJ. A computerized reminder system to increase the use of preventive care for hospitalized patients. New England Journal of Medicine 2001;345(13):965‐70. [DOI: 10.1056/NEJMsa010181] - DOI - PubMed
Fontaine 2006 {published data only}
    1. Fontaine A, Mahé I, Bergmann JF, Fiessinger JN, Dhote R, Cohen P, et al. Effectiveness of written guidelines on the appropriateness of thromboprophylaxis prescriptions for medical patients: a prospective randomized study. Journal of Internal Medicine 2006;260(4):369‐76. [DOI: 10.1111/j.1365-2796.2006.01699.x] - DOI - PubMed
Garcia 2009 {published data only}
    1. Garcia DA, Highfill J, Finnerty K, Varoz E, McConkey S, Hutchinson K, et al. A prospective, controlled trial of a pharmacy‐driven alert system to increase thromboprophylaxis rates in medical inpatients. Blood Coagulation and Fibrinolysis 2009;20(7):541‐5. [DOI: 10.1097/MBC.0b013e32832d6cfc] - DOI - PubMed
Hinchey 2010 {published data only (unpublished sought but not used)}
    1. Hinchey JA, Shephard T, Tonn ST, Ruthazer R, Herman RC, Selker HP, et al. The stroke practice improvement network: a quasi‐experimental trial of a multifaceted intervention to improve quality. Journal of Stroke and Cerebrovascular Diseases 2010;19(2):130‐7. [DOI: 10.1016/j.jstrokecerebrovasdis.2009.03.016] - DOI - PMC - PubMed
Kucher 2005 {published data only}
    1. Kucher N, Koo S, Quiroz R, Cooper JM, Paterno MD, Soukonnikov B, et al. Electronic alerts to prevent venous thromboembolism among hospitalized patients. New England Journal of Medicine 2005;352(10):969‐77. [DOI: 10.1056/NEJMoa041533] - DOI - PubMed
    1. Paterno MD, Cina JL, Goldhaber SZ, Kucher N. Preventing DVT and PE in hospitalized patients: improving a successful electronic alert. AMIA Annual Symposium Proceedings 2006:1058. [PMCID: PMC1839306] - PMC - PubMed
Labarere 2007 {published data only}
    1. Labarere J, Bosson JL, Sevestre MA, Sellier E, Richaud C, Legagneux A. Intervention targeted at nurses to improve venous thromboprophylaxis. International Journal for Quality in Health Care 2007;19(5):301‐8. [DOI: 10.1093/intqhc/mzm034] - DOI - PubMed
Overhage 1996 {published data only}
    1. Overhage JM, Tierney WM, McDonald CJ. Computer reminders to implement preventive care guidelines for hospitalized patients. Archives of Internal Medicine 1996;156(14):1551‐6. [PMID: 8687263 ] - PubMed
Pai 2013 {published data only}
    1. Pai M, Lloyd NS, Cheng J, Thabane L, Spencer FA, Cook DJ, et al. Strategies to enhance venous thromboprophylaxis in hospitalized medical patients (SENTRY): a pilot cluster randomized trial. Implementation Science 2013;8:1. [DOI: 10.1186/1748-5908-8-1] - DOI - PMC - PubMed
Piazza 2009 {published data only}
    1. Piazza G, Rosenbaum EJ, Pendergast W, Jacobson JO, Pendleton RC, McLaren GD, et al. Physician alerts to prevent symptomatic venous thromboembolism in hospitalized patients. Circulation 2009;119(16):2196‐201. [DOI: 10.1161/CIRCULATIONAHA.108.841197] - DOI - PMC - PubMed
Roy 2016 {published data only}
    1. Roy PM, Rachas A, Meyer G, Gal G, Durieux P, Kouri D, et al. Multifaceted intervention to prevent venous thromboembolism in patients hospitalized for acute medical illness: a multicenter cluster‐randomized trial. PLoS One 2016;11(5):e0154832. [DOI: 10.1371/journal.pone.0154832] - DOI - PMC - PubMed

References to studies excluded from this review

Marini 2014 {published data only}
    1. Marini BL, Funk K, Kraft MD, Fong JM, Naanos R, Stout SM, et al. The effects of an informational video on patient knowledge, satisfaction and compliance with venous thromboembolism prophylaxis: a pilot study. Patient Education and Counseling 2014;96(2):264‐7. [DOI: 10.1016/j.pec.2014.05.008] - DOI - PubMed
Nendaz 2010 {published data only}
    1. Nendaz MR, Chopard P, Lovis C, Kucher N, Asmis LM, Dörffler J, et al. Adequacy of venous thromboprophylaxis in acutely ill medical patients (IMPART): multisite comparison of different clinical decision support systems. Journal of Thrombosis and Haemostasis 2010;8(6):1230‐4. [DOI: 10.1111/j.1538-7836.2010.03817.x] - DOI - PubMed
Piazza 2013 {published data only}
    1. Piazza G, Anderson FA, Ortel TL, Cox MJ, Rosenberg DJ, Rahimian S, et al. Randomized trial of physician alerts for thromboprophylaxis after discharge. American Journal of Medicine 2013;126(5):435‐42. [DOI: 10.1016/j.amjmed.2012.09.020] - DOI - PubMed

Additional references

Adamali 2013
    1. Adamali H, Suliman AM, Zaid H, O'Donoghue E, Burke A, Suliman AW, et al. A national house‐staff audit of medical prophylaxis in medical patients for the prevention of venous thromboembolism (PREVENT‐VTE). Irish Medical Journal 2013;106(10):302‐5. - PubMed
Adams 2012
    1. Adams P, Riggio JM, Thomson L, Brandell‐Marino R, Merli G. Clinical decision support systems to improve utilization of thromboprophylaxis: a review of the literature and experience with implementation of a computerized physician order entry program. Hospital Practice (1995) 2012;40(3):27‐39. - PubMed
Akinbobuyi 2016
    1. Akinbobuyi O, Shalders L, Nokes T. Ensuring timely thromboprophylaxis on a medical assessment unit. British Medical Journal Quality Improvement Reports 2016;5(1):u212414.w4934. - PMC - PubMed
Al‐Hameed 2014
    1. Al‐Hameed F, Al‐Dorzi HM, Aboelnazer E. The effect of a continuing medical education program on venous thromboembolism prophylaxis utilization and mortality in a tertiary‐care hospital. Thrombosis Journal 2014;12:9. - PMC - PubMed
Alotaibi 2016
    1. Alotaibi GS, Wu C, Senthilselvan A, McMurtry MS. Secular trends in incidence and mortality of acute venous thromboembolism: The AB‐VTE population‐based study. American Journal of Medicine 2016;129(8):879.e19‐25. - PubMed
Amin 2009
    1. Amin AN, Deitelzweig SB. Optimizing the prevention of venous thromboembolism: recent quality initiatives and strategies to drive improvement. The Joint Commission Journal on Quality and Patient Safety 2009;35(11):558‐64. - PubMed
Amin 2012
    1. Amin AN, Deitelzweig SB. Strategies to optimize the prevention of venous thromboembolism: process improvement practices. Journal of Clinical Outcomes Management 2012;19(3):117‐24.
Anderson 2003
    1. Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation 2003;107(23):I9‐16. - PubMed
Anderson 2007
    1. Anderson FA Jr, Zayaruzny M, Heit JA, Fidan D, Cohen AT. Estimated annual numbers of US acute‐care hospital patients at risk for venous thromboembolism. American Journal of Hematology 2007;82(9):777‐82. - PubMed
Barbar 2017
    1. Barbar S, Prandoni P. Scoring systems for estimating risk of venous thromboembolism in hospitalized medical patients. Seminars in Thrombosis and Hemostasis 2017;43(5):460‐8. - PubMed
Beckman 2016
    1. Beckman MG, Abe K, Barnes K, Bartman B, Brady PJ, Hooper WC. Strategies and partnerships toward prevention of healthcare‐associated venous thromboembolism. Journal of Hospital Medicine 2016;11(Suppl 2):S5‐7. - PMC - PubMed
Bikdeli 2016
    1. Bikdeli B, Wang Y, Minges KE, Desai NR. Hospitalizations, therapies, and outcomes of pulmonary embolism in medicare beneficiaries: trends are similar to Europe. Journal of the American College of Cardiology 2016;67(21):2559‐60. - PubMed
Borab 2017
    1. Borab ZM, Lanni MA, Tecce MG, Pannucci CJ, Fischer JP. Use of computerized clinical decision support systems to prevent venous thromboembolism in surgical patients: a systematic review and meta‐analysis. JAMA Surgery 2017;152(7):638‐45. - PMC - PubMed
Bozarth 2013
    1. Bozarth AL, Bajaj N, Abdeljalil A. A review of venous thromboembolism prophylaxis for hospitalized medical patients. Hospital Practice (1995) 2013;41(3):60‐9. - PubMed
Bozzato 2012
    1. Bozzato S, Galli L, Ageno W. Thromboprophylaxis in surgical and medical patients. Seminars in Respiratory and Critical Care Medicine 2012;33(2):163‐75. - PubMed
de Miguel‐Díez 2014
    1. Miguel‐Díez J, Jiménez‐García R, Jiménez D, Monreal M, Guijarro R, Otero R, et al. Trends in hospital admissions for pulmonary embolism in Spain from 2002 to 2011. European Respiratory Journal 2014;44(4):942‐50. - PubMed
Dobesh 2010
    1. Dobesh P. The importance of appropriate prophylaxis for the prevention of venous thromboembolism in at‐risk medical patients. International Journal of Clinical Practice 2010;64(11):1554‐62. - PubMed
Dobromirski 2012
    1. Dobromirski M, Cohen AT. How I manage venous thromboembolism risk in hospitalized medical patients. Blood 2012;120(8):1562‐9. - PubMed
Egger 1997
    1. Egger M, Smith GD, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315(7109):629–34. - PMC - PubMed
Falck‐Ytter 2012
    1. Falck‐Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence‐based clinical practice guidelines. Chest 2012;141(2):e278S‐325S. - PMC - PubMed
Farfan 2016
    1. Farfan M, Bautista M, Bonilla G, Rojas J, Llinás A, Navas J. Worldwide adherence to ACCP guidelines for thromboprophylaxis after major orthopedic surgery: a systematic review of the literature and meta‐analysis. Thrombosis Research 2016;141:163‐70. - PubMed
Farge 2016
    1. Farge D, Bounameaux H, Brenner B, Cajfinger F, Debourdeau P, Khorana AA, et al. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncology 2016;17(10):e452‐66. - PubMed
Fernandez 2015
    1. Fernandez MM, Hogue S, Preblick R, Kwong WJ. Review of the cost of venous thromboembolism. ClinicoEconomics and Outcomes Research 2015;7:451‐62. - PMC - PubMed
Fiero 2016
    1. Fiero MH, Huang S, Oren E, Bell ML. Statistical analysis and handling of missing data in cluster randomized trials: a systematic review. Trials 2016;17:72. - PMC - PubMed
Fillmore 2013
    1. Fillmore CL, Bray BE, Kawamoto K. Systematic review of clinical decision support interventions with potential for inpatient cost reduction. BMC Medical Informatics and Decision Making 2013;13:135. - PMC - PubMed
Geahchan 2016
    1. Geahchan N, Basile M, Tohmeh M, DIONYS registry. Venous thromboembolism prophylaxis in patients undergoing abdominal and pelvic cancer surgery: adherence and compliance to ACCP guidelines in DIONYS registry. Springerplus 2016;5(1):1541. - PMC - PubMed
Geerts 2008
    1. Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence‐Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(6):381S‐453S. - PubMed
Geerts 2009
    1. Geerts W. Prevention of venous thromboembolism: a key patient safety priority. Journal of Thrombosis and Haemostasis 2009;7(Suppl 1):1‐8. - PubMed
Golian 2016
    1. Golian M, Moussa M, White C, Aletta G, Koley L, Seifer C. Venous thromboembolism prophylaxis on a cardiology in‐patient unit: a surprising result?. Canadian Journal of Cardiology 2016;32(2):256‐8. - PubMed
Gould 2012
    1. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in non‐orthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence‐based clinical practice guidelines. Chest 2012;141(Suppl 2):e227S‐77S. - PMC - PubMed
GRADEpro GDT [Computer program]
    1. McMaster University (developed by Evidence Prime). GRADEpro GDT. Version accessed 20 July 2017. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015.
Guyatt 2011
    1. Guyatt GH, Oxman AD, Schünemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. Journal of Clinical Epidemiology 2011;64(4):380‐2. - PubMed
Hansrani 2017
    1. Hansrani V, Khanbhai M, McCollum C. The prevention of venous thromboembolism in surgical patients. Advances in Experimental Medicine and Biology 2017;906:1‐8. - PubMed
Heit 2001
    1. Heit JA, Melton LJ 3rd, Lohse CM, Petterson TM, Silverstein MD, Mohr DN, et al. Incidence of venous thromboembolism in hospitalized patients vs community residents. Mayo Clinic Proceedings 2001;76(11):1102‐10. - PubMed
Heit 2002
    1. Heit JA, O'Fallon WM, Petterson TM, Lohse CM, Silverstein MD, Mohr DN, et al. Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population‐based study. Archives of Internal Medicine 2002;162(11):1245‐8. - PubMed
Heit 2015
    1. Heit JA. Epidemiology of venous thromboembolism. Nature Reviews Cardiology 2015;12(8):464–74. - PMC - PubMed
Heit 2016
    1. Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. Journal of Thrombosis and Thrombolysis 2016;41(1):3‐14. - PMC - PubMed
Hibbert 2016
    1. Hibbert PD, Hannaford NA, Hooper TD, Hindmarsh DM, Braithwaite J, Ramanathan SA, et al. Assessing the appropriateness of prevention and management of venous thromboembolism in Australia: a cross‐sectional study. BMJ Open 2016;6(3):e008618. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Jacobs 2012
    1. Jacobs JJ, Mont MA, Bozic KJ, Della Valle CJ, Goodman SB, Lewis CG, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. Journal of Bone and Joint Surgery. American Volume 2012;94(8):746‐7. - PMC - PubMed
Jacobs 2017
    1. Jacobs B, Pannucci C. Scoring systems for estimating risk of venous thromboembolism in surgical patients. Seminars in Thrombosis and Hemostasis 2017;43(5):449‐59. - PubMed
Jha 2013
    1. Jha AK, Larizgoitia I, Audera‐Lopez C, Prasopa‐Plaizier N, Waters H, Bates DW. The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Quality & Safety 2013;22(10):809‐15. - PubMed
Jiménez 2016
    1. Jiménez D, Miguel‐Díez J, Guijarro R, Trujillo‐Santos J, Otero R, Barba R, et al. Trends in the management and outcomes of acute pulmonary embolism: analysis from the RIETE registry. Journal of the American College of Cardiology 2016;67(2):162‐70. - PubMed
Kahn 2007
    1. Kahn SR, Panju A, Geerts W, Pineo GF, Desjardins L, Turpie AG, et al. Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thrombosis Research 2007;119(2):145–55. - PubMed
Kahn 2012
    1. Kahn SR, Lim W, Dunn AS, Cushman M, Dentali F, Akl EA, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence‐based clinical practice guidelines. Chest 2012;141(2 Suppl):e195S‐226S. - PMC - PubMed
Kakkar 2010
    1. Kakkar AK, Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Deslandes B, et al. Venous thromboembolism risk and prophylaxis in the acute care hospital setting (ENDORSE survey): findings in surgical patients. Annals of Surgery 2010;251(2):230‐8. - PubMed
Kerbauy 2013
    1. Kerbauy MN, Moraes FY, Kerbauy LN, Conterno Lde O, El‐Fakhouri S. Venous thromboprophylaxis in medical patients: an application review. Revista da Associação Médica Brasileira (1992) [Journal of the Brazilian Medical Association] 2013;59(3):258‐64. - PubMed
Khoury 2011
    1. Khoury H, Welner S, Kubin M, Folkerts K, Haas S. Disease burden and unmet needs for prevention of venous thromboembolism in medically ill patients in Europe show underutilisation of preventive therapies. Thrombosis and Haemostasis 2011;106(4):600‐8. - PubMed
Kim 2015
    1. Kim JY, Khavanin N, Rambachan A, McCarthy RJ, Mlodinow AS, Oliveria GS Jr, et al. Surgical duration and risk of venous thromboembolism. JAMA Surgery 2015;150(2):110‐7. - PubMed
Kim 2016
    1. Kim PS, Gasparis AP, ProbeckK, Elitharp D, Tassiopoulos A, Labropoulos N. Accuracy of venous thromboembolism assessment and compliance to prophylaxis in a tertiary care center. Phlebology 2016;31(8):541‐5. - PubMed
Konstantinides 2016
    1. Konstantinides SV. Trends in pulmonary embolism outcomes: are we really making progress?. Journal of the American College of Cardiology 2016;67(2):171‐3. - PubMed
Kucher 2005a
    1. Kucher N, Tapson VF, Goldhaber SZ, DVT FREE Steering Committee. Risk factors associated with symptomatic pulmonary embolism in a large cohort of deep vein thrombosis patients. Thrombosis and Haemostasis 2005;93(3):494‐8. - PubMed
Lancet Haematology 2015
    1. The Lancet Haematology. Thromboembolism: an under appreciated cause of death. Lancet Haematology 2015;2(10):e393. - PubMed
Lau 2014
    1. Lau BD, Haut ER. Practices to prevent venous thromboembolism: a brief review. BMJ Quality & Safety 2014;23(3):187‐95. - PMC - PubMed
Lecumberri 2011
    1. Lecumberri R, Panizo E, Gomez‐Guiu A, Varea S, Garcia‐Quetglase E, Serrano M, et al. Economic impact of an electronic alert system to prevent venous thromboembolism in hospitalised patients. Journal of Thrombosis and Haemostasis 2011;9(6):1108‐15. - PubMed
Liew 2017
    1. Liew NC, Alemany GV, Angchaisuksiri P, Bang SM, Choi G, Silva DA, et al. Asian venous thromboembolism guidelines: updated recommendations for the prevention of venous thromboembolism. International Angiology 2017;36(1):1‐20. - PubMed
Mahan 2010
    1. Mahan CE, Spyropoulos AC. Venous thromboembolism prevention: a systematic review of methods to improve prophylaxis and decrease events in the hospitalized patient. Hospital Practice 2010;38(1):97‐108. - PubMed
Maynard 2016
    1. Maynard G. Preventing hospital‐associated venous thromboembolism: a guide for effective quality improvement, 2nd ed. Rockville, MD: Agency for Healthcare Research and Quality; AHRQ Publication No. 16‐0001‐EF 2016.
Michota 2007
    1. Michota F. Bridging the gap between evidence and practice in venous thromboembolism prophylaxis: the quality improvement process. Journal of General Internal Medicine 2007;22(12):1762‐70. - PMC - PubMed
Minges 2015
    1. Minges KE, Bikdeli B, Wang Y, Kim N, Curtis JP, Desai MM, et al. National trends in pulmonary embolism hospitalization rates and outcomes for adults aged ≥ 65 years in the United States (1999 to 2010). American Journal of Cardiology 2015;116(9):1436‐42. - PMC - PubMed
NICE 2015
    1. National Institute for Health and Clinical Excellence. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients undergoing surgery (last updated: June 2015). www.nice.org.uk/guidance/CG92 (accessed 19 July 2017):1‐60.
Nicolaides 2013
    1. Nicolaides A, Fareed J, Kakkar AK, Comerota AJ, Goldhaber SZ, Hull R, et al. Prevention and treatment of venous thromboembolism international consensus statement (guidelines according to scientific evidence). Clinical and Applied Thrombosis/Hemostasis 2013;19(2):116‐8. - PubMed
Noboa 2006
    1. Noboa S, Mottier D, Oger E, EPI‐GETBO study group. Estimation of a potentially preventable fraction of venous thromboembolism: a community‐based prospective study. Journal of Thrombosis and Haemostasis 2006;4(12):2720‐2. - PubMed
Qaseem 2011
    1. Qaseem A, Chou R, Humphrey LL, Starkey M, Shekelle P, Clinical Guidelines Committee of the American College of Physicians. Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine 2011;155(9):625‐32. - PubMed
Randelli 2016
    1. Randelli F, Cimminiello C, Capozzi M, Bosco M, Cerulli G, GIOTTO Investigators. Real life thromboprophylaxis in orthopedic surgery in Italy. Results of the GIOTTO study. Thrombosis Research 2016;137:103‐7. - PubMed
Raskob 2014
    1. Raskob GE, Angchaisuksiri P, Blanco AN, Büller H, Gallus A, Hunt BJ, et al. Thrombosis: a major contributor to global disease burden. Seminars in Thrombosis and Hemostasis 2014;40(7):724‐35. - PubMed
Raskob 2016
    1. Raskob GE, Angchaisuksiri P, Blanco AN, Buller H, Ddungu H, Hunt BJ, et al. Venous thromboembolism: a call for risk assessment in all hospitalised patients. Thrombosis and Haemostasis 2016;116(5):777‐9. - PMC - PubMed
Schleyer 2011
    1. Schleyer AM, Schreuder AB, Jarman KM, Logerfo JP, Goss JR. Adherence to guideline‐directed venous thromboembolism prophylaxis among medical and surgical inpatients at 33 academic medical centers in the United States. American Journal of Medical Quality 2011;26(3):174‐80. - PubMed
Schünemann 2004
    1. Schünemann HJ, Cook D, Grimshaw J, Liberati A, Heffner J, Tapson V, et al. Antithrombotic and thrombolytic therapy: from evidence to application: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(Suppl 3):688S‐96S. - PubMed
Shekelle 2013a
    1. Shekelle PG, Wachter RM, Pronovost PJ, Schoelles K, McDonald KM, Dy SM, et al. Making health care safer II: an updated critical analysis of the evidence for patient safety practices. Publication No. 13‐E001‐EF. www.ahrq.gov/research/findings/evidence‐based‐reports/ptsafetyuptp.html (accessed 19 July 2017):1‐945. - PMC - PubMed
Shekelle 2013b
    1. Shekelle PG, Pronovost PJ, Wachter RM, McDonald KM, Schoelles K, Dy SM, et al. The top patient safety strategies that can be encouraged for adoption now. Annals of Internal Medicine 2013;158(5 Pt 2):365‐8. - PubMed
Shirvanian 2015
    1. Shirvanian S, Tapson VF. Venous thromboembolism: identifying patients at risk and establishing prophylaxis. Current Medical Research and Opinion 2015;31(12):2297‐311. - PubMed
Shojania 2001
    1. Shojania KG, Duncan BW, McDonald KM, Wachter RM, Markowitz AJ. Making health care safer: a critical analysis of patient safety practices. Evidence Report/Technology Assessment, No. 43. archive.ahrq.gov/clinic/ptsafety (accessed 19 June 2017):i‐x, 1‐668. - PMC - PubMed
Spencer 2007
    1. Spencer FA, Lessard D, Emery C, Reed G, Goldberg RJ. Venous thromboembolism in the outpatient setting. Archives of Internal Medicine 2007;167(14):1471‐5. - PMC - PubMed
Stein 2005
    1. Stein PD, Beemath A, Olson RE. Trends in the incidence of pulmonary embolism and deep venous thrombosis in hospitalized patients. American Journal of Cardiology 2005;95(12):1525‐6. - PubMed
Stein 2011
    1. Stein PD, Matta F, Dalen JE. Is the campaign to prevent VTE in hospitalized patients working?. Chest 2011;139(6):1317‐21. - PubMed
Stein 2012
    1. Stein PD, Matta F, Alrifai A, Rahman A. Trends in case fatality rate in pulmonary embolism according to stability and treatment. Thrombosis Research 2012;130(6):841‐6. - PubMed
Streiff 2012
    1. Streiff MB, Lau BD. Thromboprophylaxis in non surgical patients. Hematology. American Society of Hematology. Education Program 2012;2012(1):631‐7. - PubMed
Tooher 2005
    1. Tooher R, Middleton P, Pham C, Fitridge R, Rowe S, Babidge W, et al. A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals. Annals of Surgery 2005;241(3):397‐415. - PMC - PubMed
Tsai 2012
    1. Tsai J, Grosse SD, Grant AM, Hooper CW, Atrash HK. Trends in in‐hospital deaths among hospitalizations with pulmonary embolism. Archives of Internal Medicine 2012;172(12):960‐1. - PubMed
Vazquez 2014
    1. Vazquez F, Watman R, Tabares A, Gumpel C, Baldessari E, Vilaseca AB. Risk of venous thromboembolic disease and adequacy of prophylaxis in hospitalized patients in Argentina: a multicentric cross‐sectional study. Thrombosis Journal 2014;12:15. - PMC - PubMed
Wendelboe 2016
    1. Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circulation Research 2016;118(9):1340‐7. - PubMed
Zegers 2016
    1. Zegers M, Hesselink G, Geense W, Vincent C, Wollersheim H. Evidence‐based interventions to reduce adverse events in hospitals: a systematic review of systematic reviews. BMJ Open 2016;6(9):e012555. - PMC - PubMed
Zhan 2003
    1. Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA 2003;290(14):1868‐74. - PubMed

References to other published versions of this review

Kahn 2010
    1. Kahn SR, Morrison DR, Emed J, Tagalakis V, Shrier I. Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database of Systematic Reviews 2010, Issue 1. [DOI: 10.1002/14651858.CD008201] - DOI - PubMed
Kahn 2013
    1. Kahn SR, Morrison DR, Cohen JM, Emed J, Tagalakis V, Roussin A, et al. Interventions for implementation of thromboprophylaxis in hospitalized medical and surgical patients at risk for venous thromboembolism. Cochrane Database of Systematic Reviews 2013, Issue 7. [DOI: 10.1002/14651858.CD008201.pub2] - DOI - PubMed

Publication types

MeSH terms

LinkOut - more resources