VTE prevention must improve

Each year 25,000 people in the UK die from venous thromboembolism (VTE). The mortality rate is greater than the number of deaths attributable to breast cancer, AIDS and road traffic accidents combined, and 25 times greater than the number of people who die as a result of MRSA infection.1 However, an international study, ENDORSE, found that only 50% of hospitalised patients at risk for VTE received recommended prophylaxis. Furthermore, new research reveals there is widespread ignorance of the risk of developing hospital-acquired blood clots, among patients. In a study of 1,000 members of the public, not one respondent identified hospital-acquired clots as a cause for concern when going into hospital, despite it being the biggest cause of death. The study published by Lifeblood, the thrombosis charity, also revealed that only half of those who had undergone surgery had the risk of hospital-acquired clots discussed with them. “This is a widespread, life-threatening problem – both healthcare professionals and the public have a part to play to ensure that this leading cause of death is prevented as much as possible. This research clearly shows that there is a huge education gap concerning hospitalacquired blood clots,” said Professor Beverly Hunt, medical director of Lifeblood. The charity is calling for patients to engage in discussion with healthcare professionals and to ensure they are fully informed about the risks involved. Nurse specialist, Kim Carter, Lifeblood nursing director, added: “New National Institute for Health and Clinical Excellence (NICE) guidance on the prevention of hospital-acquired blood clots, together with the demand from the NHS Commissioning Framework that 90% of all adult patients are assessed for their risk of hospital-acquired clots on admission to hospital, has brought this problem to the top of the current inpatient safety agenda. It is essential to raise public awareness of this issue.” Hospital-acquired clots are known medically as “venous thromboembolism” (VTE), which is the collective term for deep vein thromboses (DVT) and pulmonary embolism. DVT occurs when a blood clot occurs in a deep vein, usually in the leg or pelvis, while pulmonary embolism is a serious and potentially fatal condition where one of the blood vessels in the lungs becomes blocked with a clot that has travelled from another part of the body, usually a DVT in the legs. Guidelines published by NICE, in partnership with the National Clinical Guideline Centre for Acute and Chronic Conditions, recommend that all patients should be assessed for risk of developing blood clots on admission to hospital and given preventative treatment that suits their individual needs. Options include blood-thinning drugs such as heparin, anti-embolism stockings and foot impulse or pneumatic devices. Importantly, this advice covers all patients admitted to hospital – including those having day-case procedures – and not just those patients having surgery. The guideline gives recommendations on how to assess if patients are at risk of developing VTE, and importantly their risk of bleeding before blood-thinning drug treatments are used. This includes considering if patients are likely to have reduced mobility for three or more days, the type of procedure they are being admitted for, the age of patients and any pre-existing conditions. Specific recommendations are also given for women who are pregnant or have given birth within the previous six weeks. Professor Tom Treasure, chair of the NICE Guideline Development Group and professor of cardio-thoracic surgery said: “This NICE guideline is vital in helping to save lives lost each year because of preventable VTE in hospital patients. Put simply, all patients without exception should be assessed on being admitted to hospital for risk of developing a blood clot, and then given preventative treatment that is appropriate for them. VTE is a silent killer – so it’s the responsibility of medical professionals to take the very simple steps set out in the guideline which can help prevent unnecessary deaths and long term illnesses.” Dr Fergus Macbeth, clinical director at NICE, added: “There is a real clinical need for this guideline. It has been reported that measures to prevent VTE in hospital patients are used inconsistently and, in many cases, patients at significant risk of developing a blood clot do not get any preventative treatment at all. Importantly, this guideline covers all patients, not only those having surgery, setting out very clearly what medical staff should now do to assess and address VTE risk.” Comprising over 500 pages, some key aspects of the recommendations include the following:

Assessment of risk

The NICE guidelines state that medical patients should be regarded as being at increased risk of VTE if they have had, or are expected to have, significantly reduced mobility for three days or more; and have one or more of the risk factors, shown in Figure 1. NICE states that surgical patients and patients with trauma should be regarded as being at increased risk of VTE if they meet one of the following criteria: