Journal of Thrombosis and Thrombolysis

, Volume 30, Issue 1, pp 1–6

Physician alerts to prevent venous thromboembolism



Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common but usually preventable complication of hospitalization associated with substantial mortality, morbidity, and health care costs. Despite published guidelines for the prevention of VTE among hospitalized patients, underutilization of prophylaxis continues to be a problem in the United States, Canada, and worldwide. Although much of the emphasis placed on prevention has focused on improving in-hospital prophylaxis, nearly 75% of patients develop VTE in the outpatient setting. Of these patients, a substantial proportion had undergone surgery or hospitalization in the three months preceding the diagnosis of VTE. While extended out-of-hospital prophylaxis has been validated in the orthopedic and surgical oncology literature, data regarding the prevention of VTE in other hospitalized patient populations after discharge have been limited. In this review article, we discuss decision support strategies for improving VTE prevention during hospitalization and at the time of discharge.


Decision support Electronic alerts Prevention Prophylaxis Venous thromboembolism 



Deep vein thrombosis


Low-molecular weight heparin


Pulmonary embolism


Venous thromboembolism


  1. 1.
    Piazza G, Goldhaber SZ (2006) Acute pulmonary embolism, part II: treatment and prophylaxis. Circulation 114:e42–e47CrossRefPubMedGoogle Scholar
  2. 2.
    Piazza G, Goldhaber SZ (2006) Acute pulmonary embolism, part I: epidemiology and diagnosis. Circulation 114:e28–e32CrossRefPubMedGoogle Scholar
  3. 3.
    MacDougall DA, Feliu AL, Boccuzzi SJ, Lin J (2006) Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome. Am J Health Syst Pharm 63:S5–S15CrossRefPubMedGoogle Scholar
  4. 4.
    Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the international cooperative pulmonary embolism registry (ICOPER). Lancet 353:1386–1389CrossRefPubMedGoogle Scholar
  5. 5.
    Piazza G, Goldhaber SZ (2005) The acutely decompensated right ventricle: pathways for diagnosis and management. Chest 128:1836–1852CrossRefPubMedGoogle Scholar
  6. 6.
    Kahn SR, Shrier I, Julian JA, Ducruet T, Arsenault L, Miron MJ, Roussin A, Desmarais S, Joyal F, Kassis J, Solymoss S, Desjardins L, Lamping DL, Johri M, Ginsberg JS (2008) Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 149:698–707PubMedGoogle Scholar
  7. 7.
    Lang IM, Klepetko W (2008) Chronic thromboembolic pulmonary hypertension: an updated review. Curr Opin Cardiol 23:555–559CrossRefPubMedGoogle Scholar
  8. 8.
    Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW (2008) Prevention of venous thromboembolism: American college of chest physicians evidence-based clinical practice guidelines (8th edition). Chest 133:381S–453SCrossRefPubMedGoogle Scholar
  9. 9.
    Nicolaides AN, Fareed J, Kakkar AK et al (2006) Prevention and treatment of venous thromboembolism. International consensus statement (guidelines according to scientific evidence). Int Angiol 25:101–161Google Scholar
  10. 10.
    Amin A, Stemkowski S, Lin J, Yang G (2007) Thromboprophylaxis rates in US medical centers: success or failure? J Thromb Haemost 5:1610–1616CrossRefPubMedGoogle Scholar
  11. 11.
    Kahn SR, Panju A, Geerts W, Pineo GF, Desjardins L, Turpie AG, Glezer S, Thabane L, Sebaldt RJ (2007) Multicenter evaluation of the use of venous thromboembolism prophylaxis in acutely ill medical patients in Canada. Thromb Res 119:145–155CrossRefPubMedGoogle Scholar
  12. 12.
    Cohen AT, Tapson VF, Bergmann JF, Goldhaber SZ, Kakkar AK, Deslandes B, Huang W, Zayaruzny M, Emery L, Anderson FA Jr (2008) Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet 371:387–394CrossRefPubMedGoogle Scholar
  13. 13.
    U.S. Department of Health and Human Services (2008) The surgeon general’s call to action to prevent deep vein thrombosis and pulmonary embolism. Accessed 11/30/08
  14. 14.
    Piazza G, Seddighzadeh A, Goldhaber SZ (2007) Double trouble for 2, 609 hospitalized medical patients who developed deep vein thrombosis: prophylaxis omitted more often and pulmonary embolism more frequent. Chest 132:554–561CrossRefPubMedGoogle Scholar
  15. 15.
    Spencer FA, Lessard D, Emery C, Reed G, Goldberg RJ (2007) Venous thromboembolism in the outpatient setting. Arch Intern Med 167:1471–1475CrossRefPubMedGoogle Scholar
  16. 16.
    Tapson VF, Decousus H, Pini M, Chong BH, Froehlich JB, Monreal M, Spyropoulos AC, Merli GJ, Zotz RB, Bergmann JF, Pavanello R, Turpie AG, Nakamura M, Piovella F, Kakkar AK, Spencer FA, Fitzgerald G, Anderson FA Jr (2007) Venous thromboembolism prophylaxis in acutely ill hospitalized medical patients: findings from the international medical prevention registry on venous thromboembolism. Chest 132:936–945CrossRefPubMedGoogle Scholar
  17. 17.
    Piazza G, Fanikos J, Zayaruzny M, Goldhaber SZ (2009) Venous thromboembolic events in hospitalised medical patients. Thromb Haemost 102:505–510PubMedGoogle Scholar
  18. 18.
    Fanikos J, Piazza G, Zayaruzny M, Goldhaber SZ (2009) Long-term complications of medical patients with hospital-acquired venous thromboembolism. Thromb Haemost 102:688–693PubMedGoogle Scholar
  19. 19.
    Kucher N, Koo S, Quiroz R, Cooper JM, Paterno MD, Soukonnikov B, Goldhaber SZ (2005) Electronic alerts to prevent venous thromboembolism among hospitalized patients. N Engl J Med 352:969–977CrossRefPubMedGoogle Scholar
  20. 20.
    Piazza G, Goldhaber SZ (2006) Venous thromboembolism guidebook, fifth edition. Crit Pathways Cardiol 5:211–227Google Scholar
  21. 21.
    Baroletti S, Munz K, Sonis J, Fanikos J, Fiumara K, Paterno M, Goldhaber SZ (2008) Electronic alerts for hospitalized high-VTE risk patients not receiving prophylaxis: a cohort study. J Thromb Thrombolysis 25:146–150CrossRefPubMedGoogle Scholar
  22. 22.
    Piazza G, Rosenbaum EJ, Pendergast W, Jacobson JO, Pendleton RC, McLaren GD, Elliott CG, Stevens SM, Patton WF, Dabbagh O, Paterno MD, Catapane E, Li Z, Goldhaber SZ (2009) Physician alerts to prevent symptomatic venous thromboembolism in hospitalized patients. Circulation 119:2196–2201CrossRefPubMedGoogle Scholar
  23. 23.
    Durieux P (2005) Electronic medical alerts––so simple, so complex. N Engl J Med 352:1034–1036CrossRefPubMedGoogle Scholar
  24. 24.
    Piazza G, Goldhaber SZ (2009) Computerized decision support for the cardiovascular clinician: applications for venous thromboembolism prevention and beyond. Circulation 120:1133–1137CrossRefPubMedGoogle Scholar
  25. 25.
    Lecumberri R, Marques M, Diaz-Navarlaz MT, Panizo E, Toledo J, Garcia-Mouriz A, Paramo JA (2008) Maintained effectiveness of an electronic alert system to prevent venous thromboembolism among hospitalized patients. Thromb Haemost 100:699–704PubMedGoogle Scholar
  26. 26.
    Fiumara K, Piovella C, Hurwitz S, Piazza G, Niles CM, Fanikos J, Paterno M, Labreche M, Stevens L, Baroletti S, Goldhaber SZ (2009) Multi-screen electronic alerts to augment venous thromboembolism prophylaxis. Thromb Haemost (in press)Google Scholar
  27. 27.
    Anderson FA Jr, Zayaruzny M, Heit JA, Fidan D, Cohen AT (2007) Estimated annual numbers of US acute-care hospital patients at risk for venous thromboembolism. Am J Hematol 82:777–782CrossRefPubMedGoogle Scholar
  28. 28.
    Hull RD, Pineo GF, Stein PD, Mah AF, MacIsaac SM, Dahl OE, Butcher M, Brant RF, Ghali WA, Bergqvist D, Raskob GE (2001) Extended out-of-hospital low-molecular-weight heparin prophylaxis against deep venous thrombosis in patients after elective hip arthroplasty: a systematic review. Ann Intern Med 135:858–869PubMedGoogle Scholar
  29. 29.
    Eikelboom JW, Quinlan DJ, Douketis JD (2001) Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: a meta-analysis of the randomised trials. Lancet 358:9–15CrossRefPubMedGoogle Scholar
  30. 30.
    Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A, Dietrich-Neto F (2002) Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 346:975–980CrossRefPubMedGoogle Scholar
  31. 31.
    Hull RD, Schellong SM, Tapson VF, Monreal M, Samama MM, Turpie AG, Yusen RD (2007) Extended-duration venous thromboembolism prophylaxis in acutely ill medical patients with recent reduced mobility: the EXCLAIM study. 2007 congress of the international society on thrombosis and haemostasis, July 6–12, 2007; Geneva, Switzerland. Late-Breaking Clinical Trials, abstract O-S-001Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Cardiovascular Division, Department of MedicineBrigham and Women’s Hospital, Harvard Medical SchoolBostonUSA

Personalised recommendations