(February 1, 2008 - Insidermedicine) More than half of hospitalized patients worldwide are at risk for venous thromboembolism (VTE). The proportion of whom receive approved VTE prophylaxis is sorely lacking and varies dramatically from country to country, according to research published in The Lancet.

Here are some recommendations from the American College of Chest Physicians (ACCP) regarding the prevention of VTE:

•    Use mechanical methods of prophylaxis primarily in patients who are at high risk of bleeding or as an adjunct to anticoagulant-based prophylaxis. Ensure these devices are complied with and used correctly.

•    Do not use aspirin alone as prophylaxis

•    When dosing low-molecular-weight heparin (LMWH), fondaparinux,  direct thrombin inhibitors, and other antithrombotic drugs that are cleared by the kidneys, take into account the presence of renal impairment.

Researchers from King’s College London conducted the ENDORSE trial, in which they analyzed the VTE risk and prophylaxis given to all patients aged 40 and over admitted to a medical ward and all patients 18 and over admitted to a surgical ward in 358 hospitals across 32 countries.

According to ACCP guidelines, 52% of the over 68,000 patients enrolled were deemed at risk for VTE. This included 64% of surgical patients and 41% of medical patients. Among the surgical patients at risk for VTE, only 58% received ACCP-recommended VTE prophylaxis. The proportion was ever lower for at-risk medical patients at 39%. Germany and Spain had some of the best prophylaxis rates, while Bangladesh and Thailand had some of the worst.

Today's research demonstrates how few at-risk hospitalized patients are actually receiving prophylaxis against VTE. Given that VTE is currently the most common preventable cause of in-hospital death, administering appropriate VTE prophylaxis has the potential to save numerous lives.

For Insidermedicine in Depth, I'm Dr. Susan Sharma.