Prognosis

The lifetime risk of VTE is estimated to be 8% overall among US adults.[145]​ VTE is one of the most common and preventable complications of hospitalisation. The rate of asymptomatic hospital-acquired deep vein thrombosis (DVT), if thromboprophylaxis is not used, is 10% to 40% after general surgery and 40% to 60% after hip surgery. The rate of symptomatic VTE is up to 5% (or more) of medical and surgical patients if thromboprophylaxis is not used.[3]​ Given the large number of VTE events attributable to hospitalisation and the finite risk period, hospital-associated VTE risk has become a key target of VTE prevention measures to reduce health-care-associated complications.[145]​

Despite the development of rigorous clinical practice guidelines that inform thromboprophylaxis, in high-risk patient groups, such as those with cancer and the critically ill, thromboprophylaxis is commonly sub-optimal and mortality rates remain high, with thrombosis being the second major cause of death in patients with cancer.[146]​ Pulmonary embolism (PE) remains the most common cause of preventable in-hospital death in the US, while postoperative VTE was also the second most-common cause of excess length of stay in the hospital in a large US-based study.[2][4]

One study found that approximately 10% of hospital-acquired VTE are preventable and can be attributed to suboptimal therapy, including inappropriate dosing and/or selection of the anticoagulant, missed dose(s) and delayed start of the anticoagulant regime (>24 hours from admission).[147]​ In addition, despite the availability of risk stratification models for VTE and bleeding, they are complex, not optimally used in clinical practice and most require external validation.[146]​ Computer-based decision tools, embedded into existing electronic health systems, along with pre-printed orders and period audits, have been shown to be effective in optimising physician adherence to thromboprophylaxis guidelines.[30][75][76][77]

Reduction of VTE incidence in medical and surgical patients is important to mitigate the risk of both initial VTE and VTE-associated sequelae, such as post-thrombotic syndrome and chronic thromboembolic pulmonary hypertension. In addition, VTE is associated with higher hospitalisation rates and longer in-hospital periods, resulting in a significant increase in the utilisation of healthcare resources.[146]​ Furthermore, approximately 20% of individuals die within 1 year of a VTE diagnosis, sometimes from VTE but often from conditions that provoked the event.[145]

Treating physicians and nurses should routinely look for signs and symptoms of deep vein thrombosis or pulmonary embolism when patients are admitted to hospital. If VTE is suspected, proper diagnostic testing must be performed rapidly to rule out this potentially deadly complication.

Patients receiving pharmacological thromboprophylaxis

Thromboprophylaxis with a pharmacological agent can also be complicated by bleeding or, less frequently, allergic reactions and heparin-induced thrombocytopenia.

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