In venous thromboembolism (VTE), a vein becomes blocked by a blood clot that can dislodge and end up in the lungs or other vital organ. Although there are well-established guidelines for the appropriate management of VTE, multiple specialties are involved in the care of patients at risk for or with established deep vein thrombosis, and individual physicians manage a relatively small number of cases per year, according to a study supported in part by the Agency for Healthcare Research and Quality (HS09348).
A University of Washington research team led by Brenda K. Zierler, Ph.D., surveyed 650 physicians (from hematologists and cardiologists to different types of surgeons) at three academic medical centers to determine their knowledge of and management strategies for VTE. Of the 128 physicians who completed the survey, only 12 percent were able to correctly identify all of the veins routinely imaged as either deep or superficial veins. Only 14 percent of physicians were able to correctly identify the range of charges for a venous duplex scan. About 70 percent of physicians said that they would not treat symptomatic isolated calf vein thrombosis. Of those, only 42 percent said that they would obtain serial duplex scans to monitor for development of further clots, even though guidelines indicate that calf deep vein thrombosis should be treated or monitored serially if anticoagulation is contraindicated.
Failure to treat and monitor this problem could lead to potentially fatal pulmonary embolism or other problems. Surgeons, who encounter VTE more often than other physicians, were the most knowledgeable in the diagnosis and management of VTE, and primary care physicians were the least knowledgeable. The researchers, who have developed an integrated care pathway (ICP) for VTE, believe that problems in the acute management of deep vein thrombosis can be overcome by implementing ICPs with preprinted orders.
Details are in "A survey of physicians' knowledge and management of venous thromboembolism," by Dr. Zierler, Mark H. Meissner, M.D., Kevin Cain, Ph.D., and D. Eugene Strandness Jr., M.D., in Vascular and Endovascular Surgery 36(5), pp. 367-375, 2002.