Objective. The effectiveness of activities to promote routine prophylaxis t
o prevent thromboembolism is difficult to assess because information about
the prevalence of prophylaxis is sparse. The aim of this study was to asses
s the prevalence of deep vein thrombosis (DVT) prophylaxis for patients at
risk in general medicine, general surgery, orthopaedics and gynaecology in
Scotland and the North of England.
Design. Retrospective case note review of a random sample of episodes of ca
re in a stratified random sample of directorates in Scotland and a convenie
nce sample in England.
Setting. Twenty acute hospital directorates in Scotland and eight in the No
rth of England.
Participants. Case notes of patients at risk of thrombosis and discharged f
rom the selected directorates in a 12-month period (n = 742).
Main outcome measures. The proportion of patients receiving prophylaxis in
each directorate.
Results. Overall, 469/526 (89%) of patients in Scotland and 199/216 (92%) i
n England received prophylaxis. The proportion varied from 71% in general m
edicine to 100% in orthopaedics. The frequency of use of different forms of
prophylaxis varied between directorates. Approximately 60% of the patients
who received prophylaxis received more than one form.
Conclusions. Prophylaxis for DVT is well established for procedures and con
ditions that are known to increase the risk of thrombosis and for which the
re are no contraindications. Additional efforts to promote prophylaxis for
these conditions are unlikely to be cost effective. Further research is nee
ded to establish whether rates are equally high in other conditions, and wh
ether the high prophylaxis rates are due to clinical effectiveness initiati
ves.