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Long-term complications from hospital-acquired acute venous thromboembolism (VTE) include recurrent VTE, postthrombotic syndrome (PTS), and chronic thromboembolic pulmonary hypertension (CTEPH). We used a probability model to estimate the number of these events among hospitalised medical patients in the 2003 United States Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample database. Of 8,077,919 hospitalised medical patients at risk for VTE, we calculate that 122,235 were stricken with deep vein thrombosis (DVT) and 32,654 with pulmonary embolism (PE). These events generated 49,843 VTE-related deaths, 28,052 recurrent DVTs, 6,680 recurrent PEs, 140,156 cases of PTS, and 5,288 cases of CTEPH over the ensuing 5 years, for a total of 180,176 patients afflicted with long-term complications of VTE. In our model, rates of pharmacological thromboprophylaxis prescribing varied across populations, ranging from 15.3% to 49.2%. When we modeled universal utilisation of pharmacological prophylaxis, the number of VTE-related deaths decreased from 49,843 to 20,739, recurrent DVT was reduced from 28,052 to 13,384, and recurrent PE was reduced from 6,680 to 3,187 events. Incident cases of PTS decreased from 140,156 to 54,651, and CTEPH decreased from 5,288 to 1,115 cases. The number of hospitalised medical patients with long-term VTE complications was reduced by 60% to 72,337. In conclusion, hospitalised medical patients are particularly vulnerable to the development of recurrent VTE, PTS, and CTEPH. These VTE complications would be reduced by more than half with universal thromboprophylaxis. Further efforts should focus on improving VTE prophylaxis utilisation.

The number of acutely ill hospitalised medical patients at risk for acute venous thromboembolism (VTE) has not been well defined. Therefore, we used the 2003 United States Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample database to estimate VTE events among hospitalised medical patients. We then modeled the potential reduction in VTE with universal utilisation of appropriate pharmacological thromboprophylaxis. We calculated that 8,077,919 acutely ill hospitalised medical patients were at risk for VTE. Heart failure, respiratory failure, pneumonia, and cancer were the most common medical diagnoses. We estimated that 196,134 VTE-related events occurred in 2003, afflicting two out of every 100 acutely ill hospitalised medical patients. These VTE-related events were comprised of 122,235 symptomatic deep venous thromboses, 32,654 symptomatic episodes of pulmonary embolism, and 41,245 deaths due to VTE. In our model, rates of pharmacological thromboprophylaxis prescription were low for various acute medical illnesses, ranging from 15.3% to 49.2%. However, with universal thromboprophylaxis, 114,174 VTE-related events would have been prevented. In conclusion, acutely ill medical patients represent a large population vulnerable to the development of VTE during hospitalisation. The number of VTE-related events would be halved with universal thromboprophylaxis. Further efforts focused on improving VTE prevention strategies in hospitalised medical patients are warranted.

Background: Information about the variation in the risk for venous thromboembolism (VTE) and in prophylaxis practices around the world is scarce. The ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting) study is a multinational cross-sectional survey designed to assess the prevalence of VTE risk in the acute hospital care setting, and to determine the proportion of at-risk patients who receive effective prophylaxis., Methods: All hospital inpatients aged 40 years or over admitted to a medical ward, or those aged 18 years or over admitted to a surgical ward, in 358 hospitals across 32 countries were assessed for risk of VTE on the basis of hospital chart review. The 2004 American College of Chest Physicians (ACCP) evidence-based consensus guidelines were used to assess VTE risk and to determine whether patients were receiving recommended prophylaxis., Findings: 68 183 patients were enrolled; 30 827 (45%) were categorised as surgical, and 37 356 (55%) as medical. On the basis of ACCP criteria, 35 329 (51.8%; 95% CI 51.4-52.2; between-country range 35.6-72.6) patients were judged to be at risk for VTE, including 19 842 (64.4%; 63.8-64.9; 44.1-80.2) surgical patients and 15 487 (41.5%; 41.0-42.0; 21.1-71.2) medical patients. Of the surgical patients at risk, 11 613 (58.5%; 57.8-59.2; 0.2-92.1) received ACCP-recommended VTE prophylaxis, compared with 6119 (39.5%; 38.7-40.3; 3.1-70.4) at-risk medical patients., Interpretation: A large proportion of hospitalised patients are at risk for VTE, but there is a low rate of appropriate prophylaxis. Our data reinforce the rationale for the use of hospital-wide strategies to assess patients' VTE risk and to implement measures that ensure that at-risk patients receive appropriate prophylaxis.