Docs fail to treat blood clots, then fail to learn from their mistakes

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Varicose VeinsA new Canadian study reveals that doctors treating patients with venous thromboses vein clots, which often become venous emboli, clots that travel to the lungs and cause potentially lethal complications fail too often to administer protective blood thinners.

The study appeared in the Canadian Journal of Cardiology, entitled Venous Thromboembolism Prophylaxis on a Cardiology In-Patient Unit: A Surprising Result? A perhaps better title, in the let s call a spade, a spade catergory, was reserved for the journal s press release: Patients at Risk for Blood Clots Are Not Receiving Recommended Treatment.

The study, led by Dr. Mehrdad Golian of the University of Manitoba and St. Boniface Hospital in Winnipeg, and colleagues there, was undertaken in order to determine whether a guideline-based protocol improves compliance with venous thromboembolism (VTE) prophylaxis guidelines. Using anticoagulants correctly is important, and can be dangerous and tricky.

They assessed ten separate, single-day audits of in a cardiology inpatient unit. All patients at high risk for VTE were included (n = 420; male/female = 282/138; ages ranged from 52-80 years). A second series of audits for protocol adherence was conducted three and five months after protocol initiation.

Prior to the educational efforts, including a guideline-based protocol, 36% of all patients considered at risk for VTE did not receive prophylaxis. Three months after the program was initiated, a surprisingly-large fraction of the patients 21 percent were still not being treated according to the recommended guidelines. Worse, that rose to 28 percent five months post-protocol.

As the authors wrote in their conclusion, there is a high rate of noncompliance with accepted guidelines for the prevention of VTE. The introduction of a guideline-based protocol significantly increased compliance, but a substantial proportion of patients still did not receive VTE prophylaxis despite meriting such therapy.

This is simply unacceptable, especially given all the electronic monitoring and EMRs (medical records) now available, with automatic flags for discrepancies in care similar to warnings for incompatible or allergy-danger drug interactions. But really: what should it take to assure our patients in dangerous situations and VTE is one such that they are getting 21st century care? How many educational interventions must it take before physicians follow simple treatment guidelines? I believe some form of disciplinary action might be necessary for repeated failures.