OBJECTIVES: To (1) evaluate compliance with American College of Chest Physicians (ACCP) guidelines for anticoagulant therapy for prophylaxis or treatment of acute venous thromboembolism (VTE), and (2) to assess Joint Commission on Accreditation of Healthcare Organizations (JCAHO) performance measures for prevention and care of VTE. METHODS: A retrospective chart review was performed by pharmacists at 32 community hospitals using an online standardized medication use evaluation form. Compliance with ACCP recommendations was assessed on the basis of dosage, duration and type of anticoagulant used. The following JCAHO performance measures were calculated using standard definitions: #5-Objective confirmation of clinically suspected VTE, #8-Anticoagulation overlap of parenteral and warfarin therapy for patients with VTE, #9-VTE patients with therapeutic International Normalized Ratio (INR), #10-Platelet count monitoring for patients with VTE receiving unfractionated heparin (UFH), #11-VTE patients on warfarin with any INR ratio > 6 during hospitalization, #12-VTE patients with a calculated creatinine clearance of < 30 mL/min that received reduced medication dosage, #13-VTE treatment for discharged patients with active cancer., #14-UFH management by nomogram/protocol, and #16-VTE education (inpatient). Results were expressed as proportions. RESULTS: A total of 902 cases were assessed. The mean age of the patients was 67.7±16.9, 385 (42.7%) were males, and 104 (11.5%) had active cancer. 732 (81.2%) patients received prophylaxis of VTE while 170 (18.8%) received treatment for acute VTE. The average length of therapy and hospital stay was 5.7±5.3 and 7.8±7.2 days respectively. Anticoagulant therapy was consistent with ACCP recommendations in 78% of cases. Percent compliance with JCAHO measure #5, #8, #9, #10, #11, #12, #13, #14 and #16 were 82.9, 67.3, 28.0, 33.5, 0.0, 30.4, 14.7, 96.2 and 44.3 respectively. CONCLUSION: Anticoagulant therapy was in compliance with ACCP recommendations in majority of cases (78%). Performance with some JCAHO measures was less than optimal. Opportunities exist to improve the prevention and treatment of VTE.