DVT Prevention: what is happening in the "real world"?

Pulmonary embolism (PE) and deep venous thrombosis (DVT) remain major problems in medicine that receive less attention from healthcare professionals and the public than either coronary artery disease or acute myocardial infarction. Furthermore, strategies proven to minimize the frequency of PE and DVT are not widely employed on a consistent and effective basis. The problem is widespread and affects patients in acute care hospitals, rehabilitation hospitals, and skilled nursing facilities, as well as high-risk individuals at home. Internists, general practitioners, and family doctors confront the greatest challenges in implementing appropriate prophylaxis. Models for effective change exist in cardiovascular and surgical practices where the imperative for prevention of further disease is insisted upon and ingrained in the culture of clinicians. We will review the epidemiology of venous thromboembolism, strategies for the primary and secondary prevention of PE and DVT, "real world" use of prophylaxis, barriers to change that exist in the "real world," and initiatives to improve day-to-day practice. We will conclude by posing 10 questions for future research on this topic.