The US Agency for Healthcare Research and Quality (AHRQ) rates thromboprophylaxis the number one patient safety strategy for patients admitted to the hospital.[2]Shojania KG, Duncan BW, McDonald KM, et al. Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ). 2001;(43):i-x;1-668.
https://www.ncbi.nlm.nih.gov/books/NBK26966
http://www.ncbi.nlm.nih.gov/pubmed/11510252?tool=bestpractice.com
Patients admitted to the hospital are increasingly burdened with disease, and immobilization contributes to making them prime candidates for the development of VTE. VTE is one of the most common and preventable complications of hospitalization. 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]Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(suppl 2):e227S-77S.
https://journal.chestnet.org/article/S0012-3692(12)60125-1/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com
Pulmonary embolism (PE) remains the most common cause of preventable in-hospital death in the US, according to the AHRQ.[2]Shojania KG, Duncan BW, McDonald KM, et al. Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ). 2001;(43):i-x;1-668.
https://www.ncbi.nlm.nih.gov/books/NBK26966
http://www.ncbi.nlm.nih.gov/pubmed/11510252?tool=bestpractice.com
Postoperative VTE was also the second most-common cause of excess length of stay in the hospital in a large US-based study.[4]Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003 Oct 8;290(14):1868-74.
https://jamanetwork.com/journals/jama/fullarticle/197442
http://www.ncbi.nlm.nih.gov/pubmed/14532315?tool=bestpractice.com
Moreover, treatment of PE or DVT entails at least 3 months of anticoagulation with significant risk of bleeding.[3]Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(suppl 2):e227S-77S.
https://journal.chestnet.org/article/S0012-3692(12)60125-1/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/22315263?tool=bestpractice.com
Even with adequate anticoagulation, a significant proportion of patients develop long-term complications. About 3% of patients with PE develop chronic pulmonary hypertension, and 20% to 50% of patients with DVT develop post-thrombotic syndrome (also known as postphlebitic syndrome).[5]Becattini C, Agnelli G, Pesavento R, et al. Incidence of chronic thromboembolic pulmonary hypertension after a first episode of pulmonary embolism. Chest. 2006 Jul;130(1):172-5.
http://www.ncbi.nlm.nih.gov/pubmed/16840398?tool=bestpractice.com
[6]Pengo V, Lensing AW, Prins MH, et al; Thromboembolic Pulmonary Hypertension Study Group. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004 May 27;350(22):2257-64.
https://www.nejm.org/doi/10.1056/NEJMoa032274
http://www.ncbi.nlm.nih.gov/pubmed/15163775?tool=bestpractice.com
[7]Kahn SR, Ginsberg JS. The post-thrombotic syndrome: current knowledge, controversies, and directions for future research. Blood Rev. 2002 Sep;16(3):155-65.
http://www.ncbi.nlm.nih.gov/pubmed/12163001?tool=bestpractice.com