New onset of venous thromboembolism among hospitalized patients at Brighamand Women's Hospital is caused more often by prophylaxis failure than by withholding treatment

Context: Guidelines to prevent venous thromboembolism (VTE) have been widel y distributed and generally have been assumed to be effective. Therefore, a mong hospitalized patients, the development of VTE is thought to occur in t he context of omitted prophylaxis. Objectives: To describe hospitalized patients who develop VTE and to determ ine whether they received antecedent prophylaxis. Design: Case series. Setting: Brigham and Women's Hospital. Patients: Three hundred eighty-four patients who developed in-hospital deep venous thrombosis or pulmonary embolism or who developed VTE within 30 day s of prior hospital discharge. Main outcome measures: The relationship of developing new-onset VTE to the use or omission of antecedent in-hospital prophylaxis. Results: Of the 384 identified patients, 272 had deep venous thrombosis alo ne, 62 had pulmonary embolism alone, and 50 had deep venous thrombosis and pulmonary embolism. Most were medical service patients; fewer than one four th were general or orthopedic surgery patients. Overall, 52% had received a ntecedent VTE prophylaxis, Thirteen deaths (3.4%) were ascribed to pulmonar y embolism, and prophylaxis was omitted in only 1 of those 13 patients. Conclusions: Most deaths from pulmonary embolism among patients hospitalize d for other conditions occurred in the setting of failed prophylaxis rather than omitted prophylaxis. High-risk patients, especially medical service p atients, warrant intensive VTE prophylaxis and close follow-up to ensure su ccessful outcomes.