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Effectiveness of a Guideline for Venous Thromboembolism Prophylaxis in Elderly Post–Acute Care Patients
A Multicenter Study With Systematic Ultrasonographic Examination
Elodie Sellier, MD;
Jose Labarere, MD;
Jean-Luc Bosson, MD, PhD;
Malika Auvray, MD;
Marie-Therese Barrellier, MD;
Claire Le Hello, MD;
Joel Belmin, MD, PhD;
Philippe Le Roux, MD;
Marie-Antoinette Sevestre, MD, MSc; for the Association pour la Promotion de l’Angiologie Hospitalière
Arch Intern Med. 2006;166:2065-2071.
Background Thromboprophylaxis in elderly patients, including post–acute care patients, is at variance with scientific evidence. The purpose of this study was to determine whether a multifaceted intervention was followed by a decrease in deep venous thrombosis (DVT).
Methods A prospective preintervention-postintervention study was conducted in 1373 patients (preintervention phase, n = 709; postintervention phase, n = 664), aged 65 years or older, enrolled in 33 hospital-based post–acute care facilities in France. An evidence-based guideline addressing pharmacologic and mechanical prophylaxis was implemented through a multifaceted intervention. The main outcome measure was any DVT diagnosed at routine comprehensive ultrasonography performed by registered angiologists.
Results A DVT was found in 91 patients (12.8%) in the preintervention phase and in 52 patients (7.8%) in the postintervention phase (P = .002). The decrease in DVT involved the calf (7.1% vs 3.6%; P = .005) and the proximal venous segments (5.8% vs 4.2%; P = .18) and remained significant after adjusting for risk factors (adjusted odds ratio of any DVT, 0.58; 95% confidence interval, 0.39-0.86). Pharmacologic prophylaxis with either low-molecular-weight heparin at the high-risk dose, unfractionated heparin, and vitamin K antagonist was similar in the 2 study groups, whereas patients in the postintervention group were more likely to use graduated compression stockings (27.4% vs 34.6%; P = .004) and less likely to receive low-molecular-weight heparin at the low-risk dose (24.7% vs 18.5%; P = .006), which was not recommended by our guideline.
Conclusions A multifaceted intervention addressing venous thromboembolism prophylaxis in post–acute care patients can be followed by a significant decrease in the rate of any DVT in elderly patients. More active interventions are needed to enforce compliance with evidence-based guidelines.
Author Affiliations: Quality of Care Unit (Drs Sellier and Labarere) and Department of Clinical Research (Dr Bosson), University Hospital, and ThEMAS, TIMC-IMAG, National Center for Scientific Research (CNRS 5525), Joseph Fourier University (Drs Labarere and Bosson), Grenoble, France; Department of Functional Explorations, University Hospital, Caen, France (Drs Auvray, Barrellier, and Le Hello); Department of Geriatrics, Charles-Foix Hospital, Assistance Publique des Hôpitaux de Paris, Ivry-sur-Seine, France (Dr Belmin); Department of Vascular Medicine, General Hospital, La Roche-sur-Yon, France (Dr Le Roux); and Department of Vascular Medicine, University Hospital, Amiens, France (Dr Sevestre).
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