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DVT and pulmonary embolism (PE) are the most common, preventable causes of hospital death in the United States. It’s estimated that DVT and PE affect between 350,000 and 600,000 people every year. Together, the conditions are estimated to contribute to approximately 100,000 deaths every year. Known as “silent” disorders, DVT and PE can occur suddenly without symptoms. As a result, the diagnosis relies on physicians having a sound index of suspicion and an ability to recognize patients at greatest risk. Pharmacologic therapies for VTE prophylaxis have proven to be safe, effective, and cost-effective in clinical studies, and use of these agents is advocated by authoritative guidelines. Nevertheless, they are currently underutilized at many healthcare facilities, resulting in preventable mortality and morbidity.

The Surgeon General recently issued a “Call to Action” to reduce the number of cases of DVT and PE in the United States. The AHRQ has added to this effort by releasing two new guides—one for patients, titled Your Guide to Preventing and Treating Blood Clots, and another for healthcare providers, titled Preventing Hospital-Acquired Venous Thromboemolism: A Guide for Effective Quality Improvement. The hope is that these resources will increase the awareness and knowledge of these potentially deadly conditions among patients and healthcare providers. Ideally, they will encourage providers and patients alike to take steps to prevent DVT and PE.

Recognizing Patients at High Risk

DVT and PE affect both men and women equally, and risk of these conditions increases with age. Each condition has been associated with hospitalization, pregnancy, obesity, cancer, major surgery, trauma, and prolonged periods of immobility. Additionally, the risk of developing these conditions is increased for patients with inherited blood clotting disorders (eg, thrombophilia) and those exposed to steroid hormones. Evidence-based clinical guidelines created by the AHRQ provide screening strategies and prophylaxis recommendations for patients at risk of DVT and PE. In May 2006, the National Quality Forum endorsed national voluntary consensus standards for the prevention and care of venous thromboembolism (VTE), which encompasses both DVT and PE. Although there appears to be identified VTE risk factors for patients, the techniques used to predict risk accurately and efficiently have not been validated. It also appears that failure to provide prophylaxis can significantly impact hospitalized patients (Table).

Establishing Prevention Protocols

Creating systematic prevention efforts with specialty-specific protocols is essential to standardizing VTE risk assessment. These efforts are at the forefront of improving prophylaxis. A standardized VTE risk assessment should stratify patients to specific risk levels. However, these levels of risk can change from person to person. As such, routine or standard reassessment is necessary. Many factors should be taken into account when adapting risk assessment protocols. For example, it’s important to establish the first-line treatment recommendation for patients at moderate VTE risk (eg, low molecular weight heparin, unfractionated heparin, or intermittent pneumatic compression). Additionally, physicians must identify which patients should receive 5,000 units of heparin every 12 hours and those who will benefit most from 5,000 units of heparin every 8 hours. An alternative prophylaxis protocol should be established for patients who are contraindicated for pharmacologic treatment.

Although data support current recommendations to prevent DVT and PE, there appears to be a disconnect between prevention methods and their execution. To avoid the needless mortality and morbidity associated with DVT and PE, increased patient awareness and education are paramount. Fortunately, the release of new guides and materials such as the ones provided by AHRQ are outlining effective strategies to help healthcare personnel and patients achieve this reachable goal.

Carolyn M. Clancy, MD, has Physician’s Weekly that she has or has had no financial interests to report.