Preventive Blood Clot Therapy Underused

Studies find hospitals don't use low-cost measures in high-risk patients

(HealthDay is the new name for HealthScoutNews.)

WEDNESDAY, July 23, 2003 (HealthDayNews) -- Not all people who are at high risk for certain types of blood clots are getting the preventive care they need.

That's the conclusion of interim data from two studies presented last week at a meeting of the International Society on Thrombosis and Haemostasis in Birmingham, England.

Specifically, the studies were concerned with venous thromboembolism (VTE), a term that refers to deep vein thrombosis (DVT), pulmonary embolism (PE), or a combination of the two. DVT occurs when a blood clot forms in the leg and blocks blood flow. These clots can lead to potentially life-threatening pulmonary embolisms, which is when the clot breaks free, travels north through the heart and lodges in a lung. The conditions affect some 250,000 to 2 million Americans every year and may be responsible for as many as 10 percent of all hospital deaths.

Acutely ill patients, especially hospitalized patients who have not had surgery, are at particular risk because of their limited mobility. People who have had surgery are routinely treated preventively and so are not at as much risk.

The first study looked at 5,451 patients at 183 sites in the United States between October 2001 and April 2002. All of the patients had been diagnosed with DVT. Of the newly diagnosed patients, only 29 percent (1,557) received preventive measures within the 30 days leading up to the diagnosis of DVT.

Researchers started recruiting patients for the second study, still under way, in 2002. So far, 403 patients have been enrolled at nine hospitals in six countries, and researchers have three-month follow-up data on 245 patients. All of the participants had been hospitalized for three or more days with an acute medical illness. Again, most of the patients did not receive preventive measures while they were hospitalized, including 43 percent of the patients who went on to develop VTE in the hospital and 66 percent of the patients who developed VTE within three months after their discharge. Only 30 percent of patients in the hospital received preventive measures against VTE.

Effective measures are widely available and inexpensive. The measures usually consist of special compression stockings or boots, a blood thinner such as injectable heparin, or a combination of both, says Dr. Samuel Z. Goldhaber, lead author of the first study and director of the Venous Theomboembolism Research Group and Anticoagulation Service at Brigham and Women's Hospital in Boston.

"Preventing a clot is very safe," adds Dr. Steven Deitelzweig, section head of hospital medicine and member of the section of vascular medicine at the Ochsner Clinic Foundation in New Orleans, which recently launched an initiative to increase physician and patient awareness of the problem. "It's a heck of a lot of less expensive to prevent a clot than treat it."

"DVT remains to be occurring at a very high prevalence; some would even call it epidemic," Deitelzweig says. "Even with prophylaxis and protocols available both in the pharmacologic and non-pharmacologic realms, it's not happening."

Part of the problem is that DVT is still, despite its evident severity, an orphan condition. "The prevention of thrombosis in medical patients is almost an afterthought. Patients are being admitted for one diagnosis. They're not admitted for this problem," Deitelzweig says. "Another reason is that really no one has taken a great deal of ownership in this disease state."

"Not all health-care professionals realize it's a big problem," Goldhaber adds. And the problem is not likely to go away, he adds. "As the population ages and as obesity becomes a bigger problem and as people are living longer with other medical illnesses, this is becoming an increasingly big problem."

Still, initiatives to counter the problem appear to be having some effect. At the Ochsner Clinic, Deitelzweig reports, more than 80 percent of physicians are administering good preventive therapy.

Goldhaber also expresses optimism. "I think the perception is changing," he says. "I think there's increasing awareness that this is not as rare as they thought it was."

More information

For more on DVT, visit Thrombosis Online. Goldhaber has also written two patient-friendly documents on blood clots for the American Heart Association journal, Circulation. They are Treatment of Blood Clots and Pulmonary Embolism and Deep Vein Thrombosis.

SOURCES: Samuel Z. Goldhaber, M.D., director, Venous Theomboembolism Research Group and Anticoagulation Service, Brigham and Women's Hospital, and associate professor, medicine, Harvard Medical School, Boston; Steven Deitelzweig, M.D., section head, hospital medicine, and member, section of vascular medicine, Ochsner Clinic Foundation, New Orleans; July 12-18, 2003, presentations, International Society on Thrombosis and Haemostasis meeting, Birmingham, England
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