Proctor MC, Greenfield L.
Thromboprophylaxis in an academic medical center.
Cardiovasc Surg 2001 Oct;9(5):426-30

Department of Surgery, University of Michigan Hospital, 2101 Taubman Center/Box
0346, Ann Arbor, MI 48109, USA.

INTRODUCTION: Questions regarding which patients require prophylaxis for
thromboembolism, what methods should be used and the appropriate duration of
treatment remain unanswered. METHODS AND MATERIALS: A retrospective review from a
single academic medical center was undertaken to evaluate prophylactic
strategies. Multiple sources of data were used to identify patients who were
prophylaxed and those who developed deep vein thrombosis or pulmonary embolism.
These data were analyzed 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%) received prophylaxis
and there were 523 thromboembolic events. Pneumatic compression 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 surgery (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 groups used pneumatic compression as
the method of choice (64.3% and 65.2%). CONCLUSIONS: Thromboembolism prophylaxis
reduces the incidence of DVT and PE, however, our study demonstrates the variable
effectiveness of each method in different types of patients. Our data suggest
that patient risk of DVT should be individually assessed and an appropriate
method of prophylaxis should be applied when warranted.