Thromboprophylaxis in an academic medical center

Introduction: Questions regarding which patients require prophylaxis for th romboembolism, what methods should be used and the appropriate duration of treatment remain unanswered. Methods and Materials: A retrospective review from a single academic medica l center was undertaken to evaluate prophylactic strategies. Multiple sourc es of data were used to identify patients who were prophylaxed and those wh o developed deep vein thrombosis or pulmonary embolism. These data were ana lyzed to determine factors associated with successful prophylaxis including age, type of prophylaxis and admitting services. Results: A total of 22,030 patients were admitted of whom 7520 (36%) receiv ed prophylaxis and there were 523 thromboembolic events. Pneumatic compress ion devices and antiembolic stockings had the lowest incidence of failure, 2.2% and 3.2% respectively. There were significant differences in the rates of prophylaxis used by the five admitting services, being highest in surge ry (40.8%) and lowest in gynecology (11.4%). However, these groups had the lowest incidence of venous thromboembolism (4.3%, 2.3%). Both of these grou ps used pneumatic compression as the method of choice (64.3% and 65.2%). Conclusions: Thromboembolism prophylaxis reduces the incidence of DVT and P E, however, our study demonstrates the variable effectiveness of each metho d in different types of patients. Our data suggest that patent risk of DVT should be individually assessed and an appropriate method of prophylaxis sh ould be applied when warranted. (C) 2001 The International Society for Card iovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.