Physician practices in the prevention of deep vein thrombosis: the MassPRO DVT Study

Numerous well-designed clinical trials have demonstrated that prophylaxis reduces the incidence of acute deep vein thrombosis (DVT) in high-risk surgical patients by two-thirds, with a corresponding reduction in mortality from pulmonary embolism. However, studies of clinical practices suggest that DVT prophylaxis is underused-for example, only 39% of high-risk surgical patients in 16 central Massachusetts hospitals were administered DVT prophylaxis in 1986. Subsequently, an intensive educational initiative was launched to improve utilization of DVT prophylaxis. Although some improvement was reported, the level of use was not optimal. The Massachusetts Peer Review Organization (MassPRO) DVT study was designed to gather data on recent practice patterns among Massachusetts surgeons and determine the need for additional educational and quality assurance efforts. The results indicate that there is broad compliance among orthopedic surgeons with consensus recommendations for the use of DVT prophylaxis. Nearly all patients who undergo total hip replacement in Massachusetts are protected from DVT by one or more methods of prophylaxis. These data suggest that the ongoing efforts to improve the use of DVT prophylaxis in Massachusetts since 1986 have come to fruition, at least with respect to total hip replacement.