Acute venous thromboembolism (VTE) is a relatively common complication in patients hospitalized for a wide variety of acute medical and surgical conditions. Over the last 30 years extensive research has demonstrated a high risk of VTE in patients who undergo major surgery or experience multiple traumas. Data documenting a significant VTE risk in patients with acute medical illness have only recently been published. However, these data are convincing and suggest that patients hospitalized for acute medical illness have approximately the same level of VTE risk as patients who undergo major general surgery. Further, the benefits of VTE prophylaxis appear similar for both medical and surgical patients.

Despite these proven benefits, it is widely suspected that VTE prophylaxis is substantially underused in medical patients, even in patients with multiple risk factors. In addition, even when prophylaxis is used, it may be used sub-optimally. Although some surveys and studies suggest that more physicians have begun to recognize VTE as a serious health problem and use prophylaxis for at least some high-risk patients, a number of recent studies demonstrate that VTE prophylaxis is underutilized.

Because there has been no systematic attempt to characterize VTE prevention among high-risk patients on a multinational basis, there is a distinct need for a comprehensive registry of VTE prevention and short-term patient outcomes. Such an effort will:

  • Describe the clinical and demographic characteristics of medical patients who do and do not receive VTE prophylaxis and document post-discharge outcomes, globally and on a hospital- and country-specific basis
  • Provide a detailed analysis of the use of pharmacological therapies and other management approaches used to minimize short- and long-term VTE complications following hospitalization for acute medical illness
  • Examine the relationship between provision of VTE prophylaxis, hospital and physician-associated outcomes, and post-discharge outcomes

Goals and Objectives

The IMPROVE (International Medical Prophylaxis Registry on Venous Thromboembolism) registry provides an opportunity to collect, analyze, and disseminate data on the clinical incidence and use of preventive measures for VTE among medical patients. Continued surveillance of the effectiveness of practices and evaluation of causes for sub-optimal outcomes are critical steps toward improving health care. The goal of the registry is to improve patient care through a better understanding of patient demographics, management, and in-hospital and post-discharge outcomes. Comparison of individual hospital data with aggregate registry data should favorably impact the quality of patient care on both a local and national scale. Once deficiencies are identified, corrective actions can be recommended to physicians who can then implement changes and assess their impact.

The objectives of the registry are to:

  • Provide timely data to physicians to characterize existing and evolving practice patterns, delivery of care, and resource utilization in the management of medical patients at risk for VTE
  • Provide data to support internal and external standards and benchmarking of prevention patterns and patient outcomes
  • Design ancillary studies to address important related questions
  • Disseminate findings through publication in peer-reviewed scientific journals

Study Management

IMPROVE is sponsored by a grant from Sanofi to the Center for Outcomes Research (COR), based at the University of Massachusetts Medical School located in Worcester, Massachusetts. COR serves as the Study Coordinating Center for the registry, which is governed by a Scientific Advisory Committee, comprised of physicians representing each participating country and clinical scientists with experience in the design and analysis of registry data. Fred Anderson, PhD, Director of COR, is responsible for the proper scientific and ethical conduct of this study, including assurance that appropriate measures for the protection of participants, including hospitals, physicians, and patients, are instituted and followed.