Blood Clot Prevention Easy, But Often Neglected by HospitalsFeb 1, 2008 | Parker Waichman LLP
Blood clots threaten over half of all hospital patients, even though there are simple ways to prevent this sometimes deadly complication. British researchers revealed that many hospitals neglect to provide preventative treatments for patients at risk for blood clots during hospital stays.
The study, published in the journal Lancet reviewed over 68,000 patients at 358 hospitals in 32 countries and found that people who underwent surgery were most likely to develop venous thromboembolism, or blood clots. "The data show that, worldwide, more than half of all hospitalized patients are at risk for venous thromboembolism and that surgical patients seem to be at higher risk than medical patients," Ander Cohen of King's College London and Ajay Kakkar at Barts and The London School of Medicine and Dentistry said.
Deep vein thrombosis (DVT) is the formation of a blood clot in one of the deep veins within the body, such as in the leg or pelvis. This kind of thrombosis can occur after surgery and may cause redness, pain, and swelling. Pulmonary embolism (PE) is a serious condition in which the arteries leading from the heart to the lungs become blocked and can occur when a clot breaks away from its original location and travels to the lungs. Symptoms may include sharp chest pain, shortness of breath, and coughing up blood. The process by which blood clots occur and travel through the veins is known as venous thromboembolism (VTE), the collective term for DVT and PE. These clot types account for about 10 percent of all in-hospital patient deaths. People undergoing surgery or medical treatment for fractures or illnesses such as cancer are at high risk of clots if they have poor circulation or are immobile for long periods. Obesity and family history are other risk factors.
Blood-thinning drugs or special stockings or boots—compression stockings or intermittent pneumatic compression (IPC) boots—improve circulation and help prevent DVT by increasing the speed at which blood flows through the veins in the legs. Researchers said half of the high-risk patients studied never received these preventative treatments. "The real conclusion you draw from this is there are very few complications that affect people in hospitals as much as blood clots," Kakkar said. "The risk factors are very common."
Researchers first determined which patients in the study were at highest risk and then checked if doctors recommended preventative measures set out in internationally accepted guidelines. The study also showed that a country's economic status was not an indicator of how well hospitals identified and treated patients at greatest risk of blood clots. For example, in surgical patients, the best performing countries were Germany, Hungary and Spain, where over 82 percent of people at highest risk received some kind of preventative treatment. The proportion in the United States and Britain was 71 percent and 74 percent, respectively. At the low end were Bangladesh and Thailand, where 0.2 percent of high-risk patients received preventative treatment, followed by Pakistan at 10 percent.
"Work is needed to improve prevention of venous thromboembolism in hospitalized patients," Walter Ageno and Frencesco Dentali of the University of Insubria in Varese, Italy, wrote in a Lancet commentary.