CMO Says Recommendations In Expert Working Group Report On Prevention Of Venous Thromboembolism Are Sensible And Practicable And Will Save Lives

Main Category: Vascular
Article Date: 19 Apr 2007 - 9:00 PDT

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Today the UK 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 [VTE]).

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 (VTE) 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 (DVT) and pulmonary embolism (PE), but also reduce the long term debilitating burden that occurs after the veins are damaged by DVT." said Professor Ian Greer, Dean of Hull York Medical School.

Additionally, the CMO has written to all doctors informing them of best practice from existing guidance that he received from the expert group and he has asked Dr Anita Thomas, the group's Chair, to lead the next phase of this important work by chairing an implementation working group. This group will develop a national risk assessment tool, and will also provide leadership both within the NHS and the wider healthcare sector in order to assess what needs to be done to ensure that a VTE risk assessment of every patient on admission to hospital becomes a reality.

Venous thromboembolism (VTE) is a serious medical problem which causes between 25,000 and 32,000 deaths in hospitalised patients each year in the UK1. VTE kills 25 times more patients than MRSA in hospitals and accounts for more than the total number of deaths from AIDS, breast cancer and traffic accidents combined1. These figures are alarming considering VTE in hospitalised patients is largely preventable through the use of medication (thromboprophylaxis)1.

Commenting today on the of the Chief Medical Officer's announcement, Eve Knight, Executive Director of Anticoagulation Europe (ACE) said, "Anyone, no matter what age, admitted to hospital, is at an increased risk of developing a blood clot. Often the condition is symptom less or 'silent', affecting patients without warning. By evaluating every patient against a simple, yet effective risk assessment chart and treating at-risk patients accordingly, many unnecessary deaths and much physical pain, emotional suffering and long term disability could be prevented."

-- More information on the CMO announcement

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About venous thromboembolism (VTE)

VTE occurs when a blood clot, formed in one of the deep veins2 (a deep vein thrombosis, known as DVT), breaks off and lodges in another part of the body. This is potentially fatal if it lodges in the lungs causing pulmonary embolism (PE)2. If not fatal the condition can cause a number of other painful conditions including post-phlebitic syndrome; a condition which results in swelling, leg pain or more seriously, leg ulceration2. There are many reasons for people to be at an increased risk of developing a potentially fatal blood clot, these risk factors include:

-- Previous VTE3

-- Increasing age4

-- Surgery4

-- Hospital or nursing home confinement4

-- Cancer4.

All physicians need to be made aware of the problems of VTE and its risk factors. Risk assessment for VTE is a simple, non-invasive procedure that will be easy to carry out in all patients when they first arrive at hospital. The assessment is based on a patient's health history and other factors such as those listed above. And with each healthcare trust being assessed on adherence to the CMO guidelines a true measure of success can be obtained.

Why is there a CMO announcement now?

The CMO announcement follows the House of Commons Health Committee inquiry 'The prevention of venous thromboembolism in hospitalised patients, second report of session 2004-51. This report highlighted a number of reasons for the alarming number of deaths caused by VTE:

1. Lack of awareness of the problem1 - a substantial number of patients who develop VTE first show signs that they have the disease after being discharged from hospital. As a result the original physician or surgeon who treated the patient in hospital is often not informed that their patient suffered from the condition after leaving their care.

2. Inconsistent guidelines1 - there are no consistent national guidelines which would ensure that doctors consider the risk of VTE and the availability of prophylaxis. In contrast, in the United States, the American College of Chest Physicians have published the 7th revision of their guidelines which were first produced in 1986.

Glossary of terms

-- Venous Thrombosis (VT): A condition in which a blood clot (thrombus) forms in a vein.

-- Deep Vein Thrombosis (DVT): venous thrombosis that occurs in the "deep veins" in the legs, thighs, or pelvis.

-- Pulmonary Embolism (PE): A blood clot that breaks off from the deep veins and travels round the circulation to block the pulmonary arteries (arteries in the lung). Most deaths arising from DVT are caused by PE.

-- Venous Thromboembolism (VTE): The blocking of a blood vessel by a blood clot dislodged from its site of origin. It includes both DVT and PE.

-- Thromboprophylaxis: A measure taken to prevent thrombosis.

References

1. House of Commons Health Committee. The prevention of venous thromboembolism in hospitalised patients. Second report of session 2004-5.
2. Hirsh J. Management of deep vein thrombosis and pulmonary embolism. Circulation 1996;93:2212-2245.
3. Alikhan R. Risk factors for venous thromboembolism in hospitalized patients with acute medical illness. Arch Int Med 2004; 164:963-968.
4. Heit JA. Venous Thromboembolism Epidemiology: Implications for Prevention and Management. Semin Thromb Hemost 2002;28 Supple2:3-13.

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