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ORIGINAL RESEARCHVENOUS THROMBOEMBOLISMVenous Thromboembolism Prophylaxis in Acutely Ill Hospitalized Medical Patients: Findings From the International Medical Prevention Registry on Venous Thromboembolism
Section snippets
Materials and Methods
Patient recruitment into the IMPROVE registry took place between July 2002 and September 2006. In contrast to randomized, controlled, clinical studies, no experimental interventions were imposed. Patient management was determined by the treating physicians, and hence the data reflect a real-world approach to VTE prevention.
Hospital and Patient Characteristics
Between July 2002 and September 2006, 15,156 patients were enrolled in the study from 52 hospitals in 12 countries (Australia, Brazil, Canada, Columbia, France, Germany, Italy, Japan, Spain, the United Kingdom, the United States, and Venezuela). Ten countries had three or more active sites, and 2 countries had two active sites each. Of the 52 hospitals participating, 15% are nonprofit public institutions, 15% are for-profit institutions, 65% are nonprofit private institutions, and the status of
Discussion
Half of acutely ill hospitalized medical patients who were enrolled in the IMPROVE study received either mechanical or pharmacologic VTE prophylaxis. Half of patients in the United States and almost half of those in other countries met the criteria of the ACCP guidelines for patients who should receive prophylaxis.10 Of these, 6 of every 10 patients actually received prophylaxis. A similar proportion of patients who would have been eligible for enrollment in the MEDENOX, PREVENT, or ARTEMIS
Appendix 1
The IMPROVE study is overseen by a medical advisory board of clinicians. Further information about the registry can be found at http://www.outcomes-umassmed.org/improve/.
Appendix 2
ACKNOWLEDGMENT
The authors thank the physicians and study coordinators participating in the IMPROVE study, and Tim Norris for providing editorial assistance in the preparation of this manuscript.
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All authors significantly contributed to the concept and design of the study, the interpretation of data, and critical revision of the manuscript. All authors approved the final version of the manuscript. Dr. FitzGerald performed all statistical analyses of data from IMPROVE.
IMPROVE is supported by an unrestricted educational grant from sanofi-aventis to the Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA.
Dr. Bergmann has received honoraria from Sanofi-Aventis and AstraZeneca. Dr. Froehlich has served as a consultant for Sanofi-Aventis. Dr. Kakkar has received consultancy/research funding from Sanofi-Aventis, sponsors of the IMPROVE registry. Dr. Merli has participated in research studies with AstraZeneca, Sanofi-Aventis, and Boehringer Ingelheim; has served on advisory boards with Bayer, Bacchus Scientific, AstraZeneca, and Sanofi-Aventis; and has been a speaker for AstraZeneca and Sanofi-Aventis. Dr. Pini has received fees from Sanofi-Aventis for being a member of the IMPROVE advisory board, and for conducting clinical studies and for lectures. Dr. Spencer has been a consultant for and has received a grant from Sanofi-Aventis. Dr. Spyropoulos has received grants/research support from and has been a consultant for Sanofi-Aventis and Astra-Zeneca. Dr. Tapson has received grants/research support from and has been a consultant for Sanofi-Aventis. Drs. Decousus, Chong, Monreal, Zotz, Pavanello, Turpie, Nakamura, Piovella, FitzGerald, and Anderson have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.