Compliance with recommended prophylaxis for venous thromboembolism: improving the use and rate of uptake of clinical practice guidelines.

Although several authoritative, evidence-based, guidelines for the prevention of venous thromboembolism (VTE) have been published, the use of VTE prophylaxis in routine clinical practice varies markedly. Even in orthopedic surgery, the indication for which prophylaxis is used most often, a significant proportion of surgeons do not use routine prophylaxis. When prophylaxis is used, guideline recommendations are often not followed. A number of factors may contribute to the under-use of guidelines. Physician-related factors include: a lack of awareness of, or familiarity with, the guidelines; a perception that VTE is not a significant problem or that VTE prophylaxis is ineffective; and concern about potential bleeding risks. The guidelines may also be perceived to be too complicated or difficult to apply in a routine manner. In addition, a lack of facilities or resources may also present a barrier to implementation of the guidelines. A number of strategies are being investigated in an attempt to improve compliance with guidelines for VTE prophylaxis. For example, the Investigators Against Thromboembolism (INATE) initiative has developed a simplified pocket guideline on VTE prophylaxis in orthopedic and trauma surgery in order to raise awareness of the current guideline recommendations.

International consensus recommendations. Summary statement and additional suggested guidelines. European Consensus Conference, November 1991. American College of Chest Physicians consensus statement of 1995. International Consensus Statement, 1997.

Since the NIH Consensus Conference in 1986, the developments in the field of prevention and treatment of venous thromboembolism were mainly characterized by a more specific and extended use of new prophylactic agents such as low-molecular-weight heparins as well as the perception that out-patients may be at risk for thromboembolic complications, too. Therefore, in 1991 and 1995, consensus conferences were held in Europe and North America in order to analyze the risk constellation of various patient populations and to give recommendations for primary prophylaxis and treatment of thromboembolic complications. The most recent, the 1997 International Consensus Recommendations are also discussed.