Compliance With Antithrombotic Guidelines: Current Practice, Barriers, and Strategies For Improvement

Deeply held, but not evidence-based, concerns about the possible risks of pharmacologic prophylaxis leave many patients at risk for DVT

Joseph A. Caprini, MD, MS, FACS, RVT
Department of Surgery, Evanston Northwestern Healthcare, Evanston, Ill., and Feinberg School of Medicine, Northwestern University, Chicago, Ill.
Thomas M. Hyers, MD, FCCP
C.A.R.E. Clinical Research, St. Louis, Mo.


Venous thromboembolism (VTE) remains a significant threat to public health despite the availability of effective and safe prophylactic measures and treatments. Guidelines based on randomized clinical trials are available to improve the management of thromboembolic disease. However, gaps exist between recommendations and clinical practice, and many patients are unnecessarily exposed to the risk of a deep vein thrombosis or potentially fatal pulmonary embolism. Barriers responsible for poor compliance with current antithrombotic guidelines include lack of familiarity with recommendations, overestimation of bleeding risk, underestimation of thrombotic risk, and logistical limitations of health care management systems. Improving compliance is a complex task, but successful initiatives rest upon improving thrombotic risk-assessment methods and facilitating appropriate prescribing of prophylaxis. Multifaceted, interdisciplinary strategies involving risk-assessment models, electronic reminders, and audit and feedback show the most potential to improve compliance with guidelines.

Correspondence to:
Joseph A. Caprini, MD
Department of Surgery
Evanston Northwestern Healthcare
Glenbrook Hospital
2100 Pfingsten Road
Glenview, IL 60025

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