Hospital Acquired DVT

AntiCoagulation Europe is committed to the prevention of thrombosis and is campaigning to make sure that proper risk assessment is performed on admission to hospital and if appropriate preventative treatment (prophylaxis) given to prevent deep vein thrombosis and pulmonary embolism. Please see below for more information.

Going into hospital?

Are you at risk?

Most people going into hospital expect to come out feeling better than when they went in. If you worry about anything, it is usually MRSA - the hospital acquired infection that you have heard about on the news.

But did you know that more than 32,000 people are dying every year in the UK from venous thromboembolism (VTE) that they acquired whilst in hospital? VTE is the umbrella name given to deep vein thrombosis (DVT) and or pulmonary embolism (PE). It is estimated that because of lack of accurate reporting this figure may be as high as 60,000. This is twenty-five times greater than the annual deaths from MRSA.

In fact, more people die from VTE than the combined figures of those who die from AIDS, breast cancer and in road traffic accidents.

It is not just the UK. VTE is a major public health problem throughout the world and contributes significantly to morbidity and mortality in all populations, especially among patients hospitalised for acute medical and surgical illness. VTE is often clinically silent in nature and difficult to diagnose.

Frequent underestimation of the risk leads to failure to provide appropriate thromboprophylaxis (drugs given to prevent clots) in many patients. The availability of effective VTE prophylaxis means that many of the events and deaths due to VTE are preventable. Image: Hospital patient with doctors

The Chief Medical Officer (CMO), Sir Liam Donaldson, announced that every hospital patient should be assessed to prevent patients developing potentially fatal blood clots (venous thromboembolism).

Within the report the expert working group made the following key recommendations:

• All patients admitted to hospital be assessed for the risk of developing blood clots (venous thromboembolism [VTE], more commonly known as DVT).
• Hospitalised patients considered at risk from VTE be considered for thromboprophylaxis medication.

Venous thromboembolism is a preventable condition. Routine risk assessment, as advised by the CMO, and appropriate treatment will go a long way to preventing not only some of the 32,000 deaths which occur each year from deep vein thrombosis and pulmonary embolism, but also reduce the long term debilitating burden. The CMO's report says that "By evaluating every patient against a simple, yet effective risk assessment chart and treating at-risk patients accordingly, many unnecessary deaths and much of the physical pain, emotional suffering and long term disability that occurs after the veins are damaged by DVT could be prevented."

Proper implementation of the guidance is essential and it needs to be uniform across the UK.There needs to be awareness and education across both secondary and primary care. People need to be made aware that they may be at risk and know what questions to ask when they are admitted to hospital.

Some thromboprophylaxis facts

• VTE in hospitalised patients is largely preventable through the use of thromboprophylaxis during the hospital stay of the patient and, in some cases, continuing after discharge.
• Thromboprophylaxis is the practice of giving small doses of anticoagulants to people with an increased risk of venous thrombosis.
• Currently there are two main forms of anticoagulation - heparin and warfarin. Heparin is given first, as it provides immediate anticoagulation. Warfarin is usually given at a later date, for a period of three to six months or longer.
• Thromboprophylaxis after general surgery may reduce the incidence of DVT from 25% to under 10%, depending on the approach used.
• Aggregated data from 21 trials of low molecular weight heparins, show an incidence of DVT of just 6% following general surgery - equivalent to a risk reduction of 76%.

References

Learn About Healthcare-Associated Venous ThromboembolismCDC. Accessed at https://www.cdc.gov on October 8, 2018.

Thrombosis. NMIHI. Accessed at http://www.nmihi.com/t/thrombosis.htm on June 8, 2018.

Venous Thromboembolism. The Joint Commission. Accessed at https://www.jointcommission.org/ on June 8, 2018.