Clinical guidelines vs. current clinical practice for the management of deep vein thrombosis: Where do we stand?

Abstract Background Deep Vein Thrombosis (DVT) is one of the major health problems worldwide with potentially serious outcomes related to mortality and morbidity. Objectives We tried to give a current view on how DVT patients are managed in routine practice compared to recommendations of published clinical guidelines. Methods A literature review has been conducted on studies reporting diagnostic and treatment patterns for acute DVT. Four dimensions have been evaluated to compare differences between clinical practice and clinical guidelines recommendations: diagnostic pathway, prescription of pharmacological treatment and related duration, prescription of compression therapy. For each aspect, the agreement with the corresponding guideline has been estimated as a percentage ranging from 0% (no agreement) to 100% (full agreement). Results Sixteen studies reported clinical practices in 10 countries. Among them, Japan showed the highest agreement with guidelines, followed by UK and Switzerland. Hong Kong showed the highest agreement with diagnosis guidelines, Spain for drug treatment, UK for treatment duration and France for compression therapy. Conversely, Germany reported a complete disagreement with guidelines for diagnosis, followed by low agreement level by UK and Italy, while Switzerland reported the lower agreement level with prescription of compression therapy. Conclusions The implementation of clinical guidelines for the management of patients with DVT varies among countries from strict adherence to no adherence at all. In this context the use of registries may be a useful tool to investigate the clinical practices and to produce findings that may be generalizable across populations.