New Warning About Hospitals and Preventable Blood Clots
One out of three U.S. hospital patients is at risk for dangerous blood clots, but far fewer actually receive treatments to prevent the potentially life-threatening condition, according to a study released this week.
“Blood clots are the most common preventable cause of death in hospital patients. It is profound and puzzling: Why is there a preventable issue that people are dying from?” Frederick Anderson, a research professor in the Department of Surgery at the University of Massachusetts Medical School and director of the Center for Outcomes Research, told United Press International.
Deep venous thromboembolism, a blood clot in the deep vein of a leg or arm, can occur when people are immobilized for two or three days, such as after surgery. The condition is treatable but if ignored, may become deadly if the blood clot travels to the lung.
It is estimated that 5 percent to 10 percent of hospital deaths are due to blood clots that travel to the lungs, also called a pulmonary embolism.
Some people have a genetic predisposition toward blood clots, experts say.
“About 100,000 die of pulmonary embolism. About half of them are in late-stage illness. But 50,000 have a good prognosis and this is a tragedy and preventable,” Anderson said. His research appears in the July American Journal of Hematology and was funded by Sanofi-aventis, which manufactures an anti-coagulant.
Clots can be prevented if patients at risk are given blood thinning drugs, and encouraged to move around if possible. Once a clot forms, blood thinning drugs must be taken for three to six months, Anderson said.
The anticoagulant is given as an injection once a day. It reduces by two-thirds the risk of a pulmonary embolism forming, Anderson said.
The problem of blood clots in hospital patients is not fully recognized by many hospitals and results in needless illness and death, Anderson said.
“There is a big gap in knowledge of this disease. No one knew just how many patients might be at risk,” Anderson said.
An overall estimate of vulnerable patients can bolster a broad, national effort to encourage physicians to recognize their at-risk patients and administer blood thinning drugs and other treatments as a preventive, Anderson said.
To get at the number, he and colleagues reviewed a national database of adult hospitalizations in 2003, a typical year, and divided the patients into categories according to their risk of a blood clot.
Anderson used accepted medical guidelines from the American College of Chest Physicians to determine who was at risk.
More than 38 million adults were hospitalized in 2003, at one or more 6,000 U.S. hospitals, according to the database.
Any person 18 or over who is hospitalized for major surgery, especially hip or knee surgery, and recovers in the hospital for two or more days is at higher risk, Anderson said. About 20 percent of patients were entered into this category.
People undergoing in-hospital hip or knee surgery have a 50-percent chance of developing a blood clot, the researchers concluded.
“Fortunately, it is unlikely you’ll die. But it is worrisome to have it there,” Anderson said of a blood clot.
Moreover, any person age 40 or over who is hospitalized for more than two days for any serious medical illness, such as heart or lung disease, cancer or infection, is also at risk. About 40 percent of people met these criteria, Anderson found.
Further criteria narrowed down those who would be most vulnerable. The result: about 12 million patients at risk of dangerous blood clots.
“Previous studies focused on single hospitals or groups but no one had every looked before at the entire population of acute-care hospitalizations,” Anderson said.
The exact reason for in-hospital blood clots is unclear but it appears that when the body is cut anywhere, such as in surgery, the entire blood system reacts. And when people are immobilized for two or three days the blood stagnates, Anderson said.
In a separate study of 10,000 U.S. patients, Anderson found that about half of those at risk of blood clots actually receive preventive treatment, but a larger study is needed, Anderson said. According to Nigel Key, professor of medicine at the University of North Carolina, the problem of dangerous blood clots is about to gain a higher profile.
“There is a plan to have the U.S. surgeon general conduct a general ‘call to action’ about thrombosis, a big public awareness campaign,” Key told UPI.
“The problem is, when the experts come up with recommendations, it can take a while for that to get translated into clinical practice,” Key said.
“It is a major killer but it hasn’t attracted the medical glamour that many other disorders have. It kills more than breast cancer and AIDS combined, but public awareness is very low,” Key said.
Valentin Fuster, past president of the American Heart Association and director of the Mt. Sinai Cardiovascular Institute, said patients and doctors can be on the lookout for situations that predispose patients to blood clots.
“If you are in bed, mobilize yourself. If it can’t be done, the doctor should give you blood thinners. On a plane, move every two or three hours. If you are undergoing an operation, the doctor should give you blood thinners. If you have varicose veins or venous diseases, you have to be very careful,” Fuster told UPI. “We should not allow this to happen,” he said.
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