Duration of deep vein thrombosis prophylaxis in the surgical patient and its relation to quality issues

Background: Venous thromboembolism (VTE) is a major cause of mortality and morbidity in patients after major surgery. The US Acting Surgeon General issued a "call to action" to reduce the number of VTE cases nationwide. Data sources: PubMed literature searches were performed to identify original studies. Results and conclusions: Noncompliance with VTE guidelines is common in clinical practice. Thromboprophylaxis is frequently stopped on discharge, not meeting recommendations for standard-duration prophylaxis (710 days) because of shorter hospital stays or for extended-duration prophylaxis (1035 days). Appropriate pharmacologic prophylaxis options for orthopedic surgery patients include the lowmolecular-weight heparins (LMWHs), fondaparinux, or warfarin (1035 days). For patients undergoing abdominal surgery for cancer, the LMWHs are recommended beyond hospitalization (up to 28 days). Performance measures should help establish VTE-prevention policies that close the gap between guideline recommendations and clinical practice in a greater number of hospitals.