Venous Thromboembolism Prophylaxis Guidelines Research Articles

Venous thromboembolism prophylaxis in ENT surgery: a survey of current practice.

Venous thromboembolism is uncommon in ENT practice. There are no specific venous thromboembolism prophylaxis guidelines for ENT surgery, despite the bleeding risks associated with ENT surgery and the low incidence of venous thromboembolism. An online poll of the ENT UK expert panel was conducted on the use of venous thromboembolism prophylaxis. A total of 132 responses were received. Of the respondents, 84.5 per cent routinely assess all of their patients for venous thromboembolism risk. In addition, 75.4 per cent use local health trust guidelines, with the National Institute for Health and Care Excellence being the most common source of national guidelines. There was significant heterogeneity in the use of low molecular weight heparin. Only 53.7 per cent of respondents felt that the guidelines they currently used reflect their practice. There is significant heterogeneity in venous thromboembolism prophylaxis. There is therefore scope for revision of the ENT UK venous thromboembolism prophylaxis guidelines to reflect general ENT practice.

The Use of Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Medical Patients: How Much Are We Adherent to the Guidelines?

Background: Venous thromboembolism (VTE) is a common complication seen during or after hospitalization that manifests as deep venous thrombosis (DVT) and/or pulmonary embolism (PE). PE is considered the commonest preventable cause of death during and/or after hospitalization. Thus, pharmacological and mechanical methods are used to prevent VTE in hospitalized patients. Despite the availability of guidelines for VTE prophylaxis, it is crucial to assess the adherence and adaptation of the institution to these guidelines. Purpose: This study aimed to investigate adherence to the American College of Chest Physicians (ACCP) 2012 VTE prophylaxis guidelines in hospitalized medical patients in a tertiary care hospital in the United Arab Emirates. Methods: An observational prospective design was utilized in this study. To achieve the purpose, primary and secondary end points were identified to be the core of the investigation. The primary end points were: the incidence of bleeding, VTE, and cardiovascular events. While the secondary end points were: dose and indication validity for prophylaxis, VTE and bleeding risk assessments, adverse drug events (ADE) other than bleeding, appropriate monitoring when on low molecular weight heparin (LMWH) and the presence of contraindication at the time of prescribing LMWH. Results: 16 patients (20%) out of the total 80 met one or more of the primary end points. The vast majority of patients (81.25%) developed bleeding, while VTE was seen in one case only during hospitalization. 11 patients (13.75%) received LMWH while a contraindication was present. 15 patients (18.75%) who were prescribed LMWH had an International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) bleeding risk score of ≥7. However, 5 out of 13 patients (38.46%) who developed bleeding had a bleeding score of ≥7, and the relationship between bleeding score of ≥7 and the development of bleeding was statistically significant (p = 0.047). When investigating the doses that were utilized, 40% were prescribed an inappropriate dose. Conclusion: Various factors played a role in the inappropriateness of VTE prophylaxis such as; poor adherence to VTE guidelines, inappropriate dosing and monitoring, and not evaluating the bleeding risk. Hence, to be able to achieve effective VTE prophylaxis, these factors need to be addressed through adherence to and adaptation of the ACCP 2012 VTE prophylaxis guidelines.

Venous Thromboembolism Prophylaxis – The Other Side of the Coin: A Review of Literature

Background : There are no local guidelines for prophylaxis against Venous Thrombo-Embolism (VTE). In the absence of any guidelines, most of the information available has been provided mainly by the pharmaceutical industry which is an interested party. There have been publications in local journals that lean more on endorsing guidelines developed elsewhere. Unfortunately, such guidelines have not been embraced by everyone even in their countries of origin yet they are sometimes presented as the universally accepted standard of care. Objective : We sought to elucidate some of the reasons for the opposition to these guidelines in this article. Our aim is not to convince readers to change their practice but to provide information that may be useful to them as they make decisions on this matter. We also hope to stimulate debate on this issue and hopefully contribute to the development of a national guideline for and by the orthopaedic community. Data source : Publications from peer reviewed journals. Results : The assumed relationship between deep vein thrombosis and pulmonary embolism is erroneous. The “post-phlebitic limb” is not always post-phlebitic. Large studies comparing the morbidity and mortality prior to and after introduction of various VTE prophylaxis guidelines find that the measures proposed by various guidelines are not efficacious. Most early deaths occurring after orthopaedic procedures are not a result of pulmonary embolism. There exists a serious conflict of interest in many of the studies that support chemo-prophylaxis for VTE prevention. The risks from chemoprophylaxis for VTE are greater than the anticipated benefit. Conclusions : Evidence adduced in this article casts doubts on the rationale and efficacy of VTE chemoprophylaxis recommendations by various international guidelines and does not support their whole-scale adoption. Recommendations : Kenya Orthopaedic Association needs to put in place mechanisms to develop local guidelines based on the local data and spearheaded by the orthopaedic fraternity.

Thromboprophylaxis use in medical inpatients and the impact of electronic risk assessment tool

▪Introduction:VTE is the third most common cause of hospital related deaths and the most common preventable cause of hospital death. Population based studies have continually emphasized the rising prevalence of VTE. As per data from CDC, VTE complicated about 550,000 hospitalizations each year in adults >18yrs. The prevalence was much higher in adults >60yrs and female sex. Pulmonary embolism accounts for about 5-10% of hospital deaths and the case fatality rates of DVT ranges between 1-10% mainly due to fatal PE and is highest in those with malignancies. VTE is associated with long term risks of post thrombotic syndrome and chronic thromboembolic pulmonary hypertension which contributes significantly to patient morbidity and cost of management.The ENDORSE trial assessed the proportion of at-risk medical patients who received thromboprophylaxis and determined that 39.5% (6119 out of 15487 patients) received ACCP-recommended VTE prophylaxis. The most effective strategies to improve prophylaxis consist of a system for reminding clinicians to assess patients for VTE risk, either electronic decision-support systems or paper-based reminders. In a recent study electronic VTE risk assessment tool (elVis) on VTE prophylaxis in hospitalised patients improved the prophylaxis rates by 5.0% amongst all patients and by 10.7% amongst high risk patients.Materials and Methods:This was a retrospective study to assess the effectiveness of a VTE (Venous Thrombo Embolism) risk assessment tool as part of the in hospital quality control initiative. A total of 400 charts were reviewed; 200 prior to implementation of the risk assessment tool, and 200 after. Patients with incomplete or missing data were excluded. A total of 388 patients were included in the study (Fig 1). These patients were randomly picked in the pre and post implementation phases of the study (April 2011 and October 2011 respectively). The hospital committee designed the risk assessment tool based on the ACCP guidelines with few modifications individualized to our patient population.The tool was an automatic and mandatory pop op that would guide the admitting resident in making a decision about VTE prophylaxis. After the tool was implemented (July 2011), all house staff were educated on its use by a dedicated lecture during a noon conference session.Results:Demographics and results of the study are shown via the following table: Table 1Pre-VTE toolPost-VTE toolNumber of patients189199Male47.9%49.7%Moderate –High Risk57.1%61.3%Individual Risk FactorsPrior VTE13.7%15.7%Chronic Pulm Disease17.9%19.1%Chronic Heart Failure14.4%16.9%Long term immobility11.7%17.4%Obesity37.2%34.3%Thrombophilia1.2%1.1%Malignancy4.6%4.7%Contraindications to anticoagulation19.04%19.06%Treatment Correctness56.3%80.3%Conclusions:This study gives us insight that VTE risk assessment tool accompanied with staff education improves VTE prophylaxis in at risk medicine inpatients. Study also confirms that incorporation of VTE prophylaxis guidelines in routine clinical practice can be assisted by electronic assessment and decision support tools. DisclosuresNo relevant conflicts of interest to declare.

Maladie thrombo-embolique veineuse et grossesse

Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality during or early after pregnancy. Prior VTE or family history of VTE, clinical or biological risk factors increased the risk of pregnancy-related VTE. Defining the risk of VTE before or at the beginning of pregnancy is necessary to propose the best prevention. However, the management is not standardized between physicians, centres and countries. Current guidelines for prophylaxis and treatment of VTE are discussed in this review.

Safety and quality outcomes in peritoneal surface malignancy patients: developing a national center for excellence in Colombia.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) is being used more frequently for the treatment of peritoneal surface malignancies. There are a paucity of data regarding safety and quality outcomes in this group of patients. The aim of this study was to evaluate safety events and quality measures in a group of patients who underwent CRS+HIPEC. All patients who underwent CRS+HIPEC procedures between December 2007 and March 2014 were included. All safety-related events and quality outcomes were reviewed. Major events were defined as occurrences in which there was harm to patient or healthcare personnel. Minor events were defined as quality or safety events in which there was potential for damage. A total of 72 patients were included. The mean Peritoneal Cancer Index for the study group was 20.5. One hundred percent compliance for informed consent, patient identification and surgical site marking, and antibiotic and venous thromboembolism prophylaxis guidelines was identified. The incidence of major safety events was 37.5%. Minor events occurred in 47.2% of patients. There was a 2.78% 30-day mortality in the study group. One in three patients undergoing CRS+HIPEC procedures experienced a major safety or quality event before, during, or after surgery. Adequate surgical care alone is not sufficient to prevent these occurrences. Active surveillance of safety events and quality leads to early detection and development of improvement plans. New CRS+HIPEC centers need to adhere to strict safety and quality guidelines to ensure excellent patient outcomes.

Venous thromboembolism prophylaxis guideline compliance: a pilot study of augmented medication charts.

Venous thromboembolism (VTE) is a common complication of hospital admission. The incidence of hospital-acquired deep vein thrombosis is approximately 10-40% amongst medical and general surgical patients without prophylaxis. Pulmonary embolism accounts for 5-10% of deaths in hospitalised patients, making hospital-acquired VTE the most common preventable cause of in-hospital death. Studies suggest that prophylactic measures are widely under- and inappropriately used. We hypothesised that the introduction of a medication chart with a dedicated VTE prophylaxis section would improve compliance with local guidelines. Trial medication charts were piloted over a 4-week period in one surgical and two medical wards. Data on compliance with hospital guidelines were collected before and after introduction using a detailed chart review. The difference in prescribing compliance was assessed with the Chi-squared test. 70 patients were assessed before and 38 after the introduction of the new charts. Initially, only 58.6% (n = 41) of patients' prescriptions were in compliance with local guidelines. In 28.6% (n = 20) of patients, VTE prophylaxis was needed and not prescribed. 7.1% (n = 5) of patients were prescribed an inappropriately low dose of low molecular weight heparin (LMWH) prophylaxis. 2.9% (n = 2) of patients were prescribed inappropriately high dose of LMWH prophylaxis. After introduction of the new medication chart, compliance with guidelines rose to 71% (n = 27, p = 0.09). Compliance with VTE guidelines is inadequate. Medication charts with specific sections on VTE assessment and prophylaxis may increase compliance with guidelines.

Abstract 214: Trends in Venous Thromboembolism in Hospitalized Heart Failure Patients in the United States: Analysis of the 2002 to 2011 Nationwide Inpatient Sample Database

Background: Hospitalized patients with heart failure (HF) are at increased risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), and these conditions are associated with increased in-hospital mortality, longer length of stay and higher healthcare costs. Guidelines have emphasized the need for DVT prophylaxis, but it is unclear if the incidence of VTE has changed or remained constant over the past years. Objectives: To determine temporal trends in incidence and outcomes of VTE in hospitalized HF patients. Methods: We used the 2002 to 2011 Nationwide Inpatient Sample databases to identify all HF-associated hospitalizations in patients aged ≥18 years. Patients with VTE (DVT or PE) were then identified using appropriate ICD-9-CM codes. We stratified patients according to age, gender, and primary or secondary HF hospitalizations. Logistic regression analysis was used to examine temporal trends in incidence and outcomes of VTE as well as to compare outcomes between HF patients with or without VTE. Results: The overall incidence of DVT, PE and VTE among 42,573,726 HF-associated hospitalizations was 1.5%, 1.0% and 2.5%, respectively. From 2002 to 2011, there was a significant increase in the incidence of DVT (1.2% to 1.6%, adjusted OR 1.35, 95% CI 1.33-1.36), PE (0.8% to 1.2%, adjusted OR 1.91, 95% CI 1.88-1.93), and VTE (2.0% to 2.8%, adjusted OR 1.56, 95% CI 1.55-1.58). Similar upward trend was observed in all age groups, men and women, as well as primary and secondary HF hospitalizations. In-hospital mortality decreased in HF patients without VTE (6.9% to 5.0%; adjusted OR 0.81, 95% CI 0.80-0.81) as well as those with VTE (13.3% to 9.8%, adjusted OR 0.79, 95% CI 0.74-0.85) during the study period. However, compared to HF patients without VTE, those with VTE had significantly higher in-hospital mortality, longer length of stay, and higher total hospital charges (Table). Conclusion: Despite the aggressive guidelines for DVT prophylaxis, the overall incidence of VTE in hospitalized HF patients has increased over the past 10 years. This may be explained by increasing co-morbidities and aging of the HF population. Further studies are needed to explain these adverse trends and to examine rates of adherence to VTE prophylaxis guidelines in this high-risk patient population.

G245(P) Routine, structured assessment for venous thromboembolism risk in surgical admissions to a tertiary children’s hospital

AimsPrevalence of paediatric venous thromboembolism (VTE) is estimated at 5.3 per 10,000 hospital admissions.There is a bimodal distribution of incidences with peaks in the neonatal period and in adolescence. 90%...

Venous Thromboembolism Risk Assessment, Prophylaxis Practices and Interventions for its Improvement (AVAIL-ME Extension Project, Iran)

Venous thromboembolism (VTE) is a major health issue worldwide. Data about VTE prophylaxis practices in developing countries are scarce. The primary objectives of this survey were to define the VTE risk factors in hospitalized patients, to determine the rates of VTE prophylaxis administration and guideline compliance and to assess the effects of an educational program on VTE prophylaxis practices in Iran. Data on 1219 patients from twenty hospitals in Iran were extracted from the AVAIL-ME Extension project main databank. VTE risks were categorized according to the Caprini Risk Assessment Model. Logistic regression analysis was carried out to assess factors influencing VTE prophylaxis. We also examined the impact of an educational program which consisted of awareness, risk assessment, internal protocol implementation and re-assessment, on VTE prophylaxis practices. Of 1219 patients, 789 (65%) and 430 (35%) were surgical and medical, respectively. VTE risks, categorized in low, moderate, high and very high were detected in 14%, 17%, 26% and 43% of patients respectively with a total of 1042(85%) patients being at risk for VTE. Of 882 (85%) eligible patients for VTE prophylaxis, 737 (83.5%) received any drug prophylaxis of whom 265 (62%) were medical and 472 (60%) were surgical. ACCP guidelines compliance was 60% and 33% in surgical and medical patients respectively. Any VTE prevention, drug prophylaxis, mechanical prophylaxis and guideline adherence were, 48% vs. 64%, 45% vs. 60%, 6% vs. 9% and 34% vs. 45% respectively (p<00.1) before and after implementation of the VTE educational program. Despite an overall improvement in VTE prevention, areas such as inappropriate use of VTE prophylaxis in a large number of patients, significant under-use of mechanical devices and guideline adherence require closer attention. VTE awareness education is beneficial in improving VTE prophylaxis in Iran.

Venous Thromboembolism After Trauma

No national standardized guidelines exist to date for venous thromboembolism (VTE) prophylaxis after pediatric trauma. While the risk of VTE after trauma is generally lower for children than for adults, the precise age at which the risk of VTE increases is not clear. To identify the age at which the risk of VTE after trauma increases from the low rate seen in children toward the higher rate seen in adults. Multivariable logistic regression models were used to estimate the association between age and the odds of VTE when adjusting for other VTE risk factors. Participants included 402 329 patients 21 years or younger who were admitted following traumatic injury between January 1, 2008, and December 31, 2010, at US trauma centers participating in the National Trauma Data Bank. Diagnosis of VTE as a complication during hospital admission. Venous thromboembolism was diagnosed in 1655 patients (0.4%). Those having VTE were more severely injured compared with those not having VTE and more frequently required critical care, blood transfusion, central line placement, mechanical ventilation, and surgery. The risk of VTE was low among younger patients, occurring in 0.1% of patients 12 years or younger, but increased to 0.3% in patients aged 13 to 15 years and to 0.8% in patients 16 years or older. These findings remained when adjusting for other factors, with patients aged 13 to 15 years (adjusted odds ratio, 1.96, 95% CI 1.53-2.52; P < .001) and patients aged 16 to 21 years (adjusted odds ratio, 3.77; 95% CI, 3.00-4.75; P < .001) having a significantly higher odds of being diagnosed as having VTE compared with patients aged 0 to 12 years. These findings were consistent across the level of injury severity and the type of trauma center. The risk of VTE varies considerably across patient age and increases most dramatically at age 16 years, after a smaller increase at age 13 years. These findings can be used to guide future research into the development of standardized guidelines for VTE prophylaxis after pediatric trauma.

Postoperative Venous Thromboembolism Prophylaxis by General Surgeons in a Developing Country: A Survey

Venous thromboembolism (VTE) is the most common preventable cause of hospital death. Several audits in the west have demonstrated that appropriate thromboprophylaxis is not being offered to a large number of surgical patients. Similar audits are lacking in the Indian population, and a perception exists among Indian surgeons that Indian patients are not susceptible to VTE. Hence we undertook a survey to analyze the existing knowledge and practice of VTE prophylaxis amongst general surgeons in India. A questionnaire-based survey was conducted on 100 active general surgeons. We found that 97% of surgeons had encountered VTE in their practice, and 49% had encountered mortality from pulmonary embolism. 64% of surgeons do not routinely score patients preoperatively for their VTE risk, and only 33% reported the presence of an institute-based protocol for the same. There was a wide disparity in the prophylaxis methods used for each risk group, particularly in the moderate-risk group. These findings suggest the need for adoption of institute-based protocols for prophylaxis and the evolution of Indian guidelines for VTE prophylaxis.

Review of thromboembolic prophylaxis in patients attending Cork University Hospital

Although preventable, venous thromboembolism remains a common cause of hospital acquired morbidity and mortality. Guidelines, such as the one produced by the American College of Chest Physicians (ACCP), are aimed at reducing hospital associated venous thromboemboli. Unfortunately the majority of studies have revealed inadequate adherence to these guidelines. The objective of this study was to evaluate the use of venous thromboembolism prophylaxis at Cork University Hospital. Cork University Hospital, Wilton, Cork, Ireland. Data from the patient's chart, drug kardex and laboratory results were recorded during April 2010. A Caprini score, a venous thromboembolism risk factor assessment tool, was subsequently calculated for each patient based on data collected. Appropriate prophylaxis was determined after examining data collected, Caprini score and prophylactic regime according to the ACCP 8th edition guidelines. Primary outcome was to analyse adherence to VTE prophylaxis guidelines. A total of 394 patients met the inclusion criteria and were reviewed, of which, 60% (n = 236) were medical and 37% (n = 146) were surgical patients. In total 63% of patients received some form of venous thromboembolism prophylaxis. Furthermore, 54% of medical and 76% of surgical patients received prophylaxis. However only 37% of the patients studied received appropriate thromboprophylaxis according to the ACCP 8th edition guidelines (Geerts et al. in chest 133(6 Suppl):381S-453S, 2008). Additionally 51% of surgical and 27% of medical patients received appropriate prophylaxis. Data collected from Cork University Hospital revealed poor adherence to international venous thromboembolism prophylaxis guidelines. As stated in the ACCP 8th edition guidelines, every hospital should develop a formal strategy for venous thromboembolism prevention (Geerts et al. in chest 133(6 Suppl):381S-453S, 2008). In order to improve adherence to guidelines, Cork University Hospital should develop, implement and re-evaluate a specific protocol for venous thromboembolism prophylaxis.

Readmission Following Total Knee Arthroplasty: Venous Thromboembolism as a “Never Event” Is a Counterproductive Misnomer

A national quality improvement initiative identifies certain avoidable complications as “never events,” and includes venous thromboembolism (VTE). This study examines the incidence and cost of VTE following total knee arthroplasty (TKA) compared to other causes of readmission and the degree to which VTE was preventable. One hundred twenty-one readmissions (105 patients) were reviewed to determine the reason for readmission, cost, and compliance with SCIP VTE prophylaxis guidelines. The most common reasons for readmission were limited motion (18.2%), wound complication (14%), surgical site infection (9.9%), and bleeding (9.9%). VTE was less common (3.3%), and all occurred despite adequate prophylaxis. The cost of bleeding, wound complications, infection, and limited motion each exceeded the cost of VTE. These results challenge the identification of VTE as a “never event.”

Prevention of venous thromboembolism in hospitalized patients: Analysis of reduced cost and improved clinical outcomes

The impact of implementing a guideline on venous thromboembolism (VTE) prophylaxis was evaluated in a metropolitan private hospital with a before- and after-intervention study. This subsequent study aimed to identify if improved prophylaxis rates translated into cost savings and improved clinical outcomes. A conceptual decision-tree analytical model incorporating local treatment algorithms and clinical trial data was used to compare prophylaxis costs and clinical outcomes before and after the guideline implementation. The study analyzed data from 21,942 medical and surgical patients admitted to a 250-bed acute-care private hospital in Sydney, Australia. The modeled simulation estimated the incidence of symptomatic deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as adverse events such as heparin-induced thrombocytopenia (HIT), post-thrombotic syndrome (PTS), major bleeding, and mortality. The costs of prophylaxis therapy and treating adverse events were also calculated. The improvement in prophylaxis rates following the implementation of the guideline was estimated to result in 13 fewer deaths, 84 fewer symptomatic DVTs, 19 fewer symptomatic PEs, and 512 fewer hospital-bed days. Improved adherence to evidence-based prophylaxis regimens was associated with overall cost savings of $245,439 over 12 months. We conclude that improved adherence to evidence-based guidelines for VTE prophylaxis is achievable and is likely to result in fewer deaths, fewer VTE events, and a significant overall cost saving.

CPC-102 Pharmacist-Driven Interventions Improve Thromboprophylaxis in Acutely Ill Medical Patients Over Time – Results After Six Months

BackgroundForty to 50% of hospitalised patients with an acute medical illness have risk factors for venous thromboembolism (VTE) and it has been shown that thromboprophylaxis reduces the incidence of VTE...

Comparison of three risk assessment methods for venous thromboembolism prophylaxis

Venous thromboembolism (VTE) is a major problem for hospitalized patients. Nevertheless, adherence to VTE prophylaxis guidelines is suboptimal, partly because of physicians' neglect due to excessive workload. Simplified risk assessment methods (RAMs) facilitate timely risk stratification and thromboprophylaxis. However, the accuracy of such RAMs has not been extensively studied. Using the prospectively collected data from hospitalized patients of Masih-Daneshvari Hospital, we tested the accuracy of the Goldhaber RAM and the Harinath and St. John RAM for VTE prophylaxis, compared with the eighth edition of the American College of Chest Physicians (ACCP) recommendations. We evaluated 1091 patients. With reference to the ACCP recommendations, both RAMs had high specificities for detection of patients at risk of VTE (97.33 and 99.11%, respectively); however, we found significant interdepartment differences. The Goldhaber RAM had superior accuracy in medical oncology patients (P = 0.03), whereas the Harinath and St. John method was superior among surgical patients (P < 0.001). Overall accuracies of Goldhaber RAM for appropriate VTE risk assessment and for proper detection of at-risk patients were close to 60%. Corresponding figures were close to 70% for the Harinath and St. John method. Simplified VTE prophylaxis RAMs are valuable, especially for transmitting electronic alerts and for timely risk assessment and thromboprophylaxis. Both of the studied RAMs had high specificities and positive-predictive values, minimizing the risk of overprophylaxis. Improving the sensitivity of such RAMs can help for timely risk assessment for a greater array of real-world patients.

Lack of Adherence With Quality Guidelines for Post-Discharge Venous Thromboembolism Prophylaxis After Colorectal Cancer Surgery in the U.S

Lack of Adherence With Quality Guidelines for Post-Discharge Venous Thromboembolism Prophylaxis After Colorectal Cancer Surgery in the U.S

Development of consensus guidelines for venous thromboembolism prophylaxis in patients undergoing microvascular reconstruction of the mandible

Development of consensus guidelines for venous thromboembolism prophylaxis in patients undergoing microvascular reconstruction of the mandible

Variations in risk assessment models may contribute to the existing gap between venous thromboembolism prophylaxis guidelines and adherence

BackgroundRisk assessment models (RAMs) may allow the clinician to determine need for deep vein thrombosis (DVT) prophylaxis. Individual healthcare facilities often develop their own RAMs. The purpose of this study was to determine: 1.) inter-RAM variability in DVT risk factors and contraindications; 2.) inter-rater variability and inter-RAM variability when applying a RAM to a standard case; and 3.) inter-rater and inter-RAM variability in outcome as far as type of prophylaxis. A convenience sample of RAMs was obtained from various institutions and ten reviewers were recruited to apply the RAMs to three patient cases.FindingThe review resulted in 390 separate assessments. Patient 1 did not receive any chemoprophylaxis in 67% of the evaluations, patient 2 in 27% of the evaluations and patient 3 in 2.3% of the evaluations. There was statistically significant variation in the provision of chemoprophylaxis per RAM for patient 1 (p=0.001) and no significant variation for patients 2 and 3. When analyzing the rate of chemoprophylaxis per reviewer, there was statistically significant variation for patients 1 and 2 (p=0.026 and <0.0001 respectively) but not for patient 3 (p=0.123).ConclusionThere may be significant inter-RAM and inter-reviewer variability when utilizing RAMs for assessing DVT risk.