MedWire News: Physicians' understanding of deep vein thrombosis (DVT), its risk factors, and associated complications varies according to their specialty and level of training, US research shows.
These differences are accompanied by variations in prophylaxis practices and understanding of prophylaxis contraindications, say Erin Galbraith (Emory University Hospitals, Atlanta, Georgia) and colleagues.
"Despite the guidelines and data indicating that DVT prophylaxis measures can decrease the incidence of DVT significantly, many studies indicate that DVT prophylaxis is being underused," remark the researchers.
To identify possible reasons for this discrepancy, they invited all medical and surgical residents, and hospitalist attending physicians at the University of Michigan hospitals to participate in an on-line survey that assessed awareness of DVT epidemiology, risk factors, prophylaxis practices, and complications.
The majority of participants accurately felt that 10-20% of all hospitalized medical patients develop DVT, the research team reports.
However all three physician groups overestimated the risk for pulmonary embolism, saying that it accounts for nearly 40% of in-hospital patient deaths whereas autopsy studies put this number at 10-14%.
When questioned about DVT risk factors, surgical residents listed paralysis as high-risk and minor surgery as low-/no-risk, while the medical residents and hospitalist attending physicians thought that these two groups of patients had a moderate DVT risk.
In contrast, medical residents thought heart failure and varicose veins were associated with low or no risk for developing DVT, while the other two groups reported these as moderate risk factors.
All three groups felt that prophylaxis decreased the incidence of DVT in hospitalized patients by 50-60%, which the researchers say is consistent with a recent meta-analysis of anticoagulant prophylaxis.
Surgical residents did not identify ambulation as a prophylactic measure, and were most likely to use sequential compression devices, compression stockings, and enoxaparin for prophylaxis, while medical residents and hospitalist attending physicians prescribed unfractionated heparin most frequently.
All three physician groups said that they would withhold prophylaxis when patients had comorbities, particularly active bleeding and recent head trauma. Of note, the hospitalist attending physicians were the least likely and medical residents were the most likely to withhold prophylaxis in general.
"An understanding of how physicians interpret various risk factors and implement prophylaxis practices is essential to advancing guideline implementation," conclude Galbraith and co-authors in the Journal of Thrombosis and Thrombolysis.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
Free abstract
