Evaluation of the efficacy of venous thromboembolism prophylaxis guideline implementation in Japan

Purpose: In Japan, the incidence of venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), has been relatively low; however, the incidence has recently been increasing. Since April 2004, we have developed an original computer-linked VTE prophylaxis in order to decrease the incidence of in-hospital VTE. Our objective has been to evaluate the efficacy of the VTE prophylaxis guideline. Methods: A retrospective pre- and postintervention study was conducted (preintervention phase, n = 17 854; postintervention phase, n = 26 831). Data were obtained from the clinical records of patients who underwent vascular surgery and were screened for DVT at our institution. Results: The frequency of patients screened for DVT increased significantly from 70 (0.4%) to 209 (0.8%) after the establishment of a guideline (P < 0.001). Asymptomatic DVT patients increased from 5 (12.5%) in the control group to 33 (50.0%) in the intervention group (P < 0.0001), while symptomatic DVT events with leg swelling decreased from 29 (72.5%) to 16 (24.2%) (P < 0.0001). Furthermore, shock and massive PE events were significantly lower (from 31.3% to 0%; P < 0.05). Conclusion: Our VTE prophylaxis guidelines are considered to be useful for the detection of asymptomatic DVT patients during hospitalization, thus leading to a significantly lower incidence of postoperative VTE.