The eighth American college of chest physicians guidelines on venous thromboembolism prevention: implications for hospital prophylaxis strategies

Venous thromboembolism (VTE) is the most common potentially preventable form of hospital-related mortality. It presents as a major healthcare burden, affecting both medical and surgical patients. The prevention of VTE has been identified as one of the most important in-hospital safety practices in the US. VTE guideline recommendations provide a framework for clinical practice and guide VTE prophylaxis policies. Guidelines produced by the American College of Chest Physicians (ACCP) are considered to be the ‘gold standard’ in VTE prevention, diagnosis and management, and have been updated. A number of differences exist between the new 2008 ACCP guidelines on VTE prevention and the previous version published in 2004. There are variations regarding VTE prevention, including new and stronger evidence-based recommendations for several indications and agents. The updated guidelines give a strong recommendation that every hospital develop a VTE prevention policy, which is particularly important given the current international drive to reduce the incidence of VTE. A formal hospital policy should help improve compliance with appropriate VTE prophylaxis strategies. The ACCP guidelines form a basis for improving patient safety at a time of public reporting of quality of care, hospital accreditation, national standards of care, and pay for performance initiatives. In this review, changes in recommendations for VTE prevention in the 2008 ACCP guidelines compared with the previous edition in 2004 are outlined. In addition, outstanding areas of debate are discussed and the role of the 2008 ACCP guidelines in the context of the new VTE performance measures analyzed.