STOP using antiembolism stockings to prevent DVT

START using prophylactic LMWH and/or pneumatic compression devices to prevent VTE

Louis E. Phaneuf Professor of Obstetrics and Gynecology, Tufts University School of Medicine, and Chair, Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, Massachusetts. Dr. Norwitz serves on the OBG Management Board of Editors.

The author reports no financial relationships relevant to this article.

Venous thromboembolism (VTE)—deep vein thrombosis (DVT) and pulmonary embolism (PE)—remains a major cause of morbidity and mortality in the United States, resulting in an estimated 200,000 deaths each year.¹ VTE is especially common among inpatients; hospitalization increases the risk of VTE eightfold,² and VTE is the most common preventable cause of hospital-associated deaths.^2,3 Most general medical and surgical inpatients have risk factors for VTE and, without prophylaxis, between 10% and 40% will develop DVT or PE.³ VTE is estimated to cost the US economy $4 billion annually in direct costs and substantially more in indirect costs, including lost productivity and subsequent medical expenses.⁴

There is no doubt that thromboprophylaxis is effective in preventing VTE in high-risk patients.^2,3,5-7 For this reason, the Agency for Healthcare Research and Quality ranks VTE prophylaxis as the single most important patient safety initiative deserving of more widespread implementation.⁸ The importance of this intervention has also been acknowledged by the Joint Commission,⁹ and by the Centers for Medicare & Medicaid Services, which include VTE prophylaxis in their Surgical Care Improvement Project (SCIP) quality measures that guide hospital reimbursement.¹⁰