Too few get vetted for clotting risk
EXPERTS have urged federal, state and territory governments to ensure hospitals assess every patient’s risk of developing potentially fatal blood clots after an international study found fewer than half those at risk were receiving preventive treatments.
Health departments in NSW and Queensland have already adopted new guidelines on preventing clots, and the trans-Tasman working party that drew them up is calling on other states to follow suit.
The Australia and New Zealand Working Party on the Prevention of Venous Thromboembolism (VTE) says VTE, the technical term for clots that form in the veins, is a leading cause of preventable hospital deaths, killing up to 10,000 people in Australian hospitals each year.
VTEs can be fatal if they travel to the lungs, where they can lodge and block blood flow. These cases, known as pulmonary emboli, are estimated to be responsible for 10 per cent of hospital deaths.
Professor John Fletcher, chairman of the working party, said the number of lives taken by VTE was greater than the number of lives taken by lung cancer and breast cancer combined.
‘‘ Hospitals can and should be taking routine steps to implement better quality and safety measures to prevent blood clots in patients as a matter of priority,’’ Fletcher said.
Just two weeks ago The Australian reported (February 7) that a study in The Lancet had found that while half of Australian hospital patients admitted for nonsurgical treatments were at risk of VTE, just 42 per cent of that number received preventive treatments.
The international study ( Lancet 2008;371:387-94) involved nearly 70,000 hospital patients in 32 countries — including 1200 patients at eight hospitals in Australia.
While VTE risk has been widely recognised in surgical patients, the medical community has been slower to take the risk seriously in medical patients, who are admitted for treatment of various conditions not requiring surgery, said Alex Gallus, the co-ordinator of the Australian arm of the study and professor of haematology at Flinders University.
These patients include those admitted for treatment of heart attack and stroke, lung diseases, cancer and other conditions.
Although 49 per cent (406) of the 834 Australian medical patients in the study were judged to be at risk of VTE, only 51 per cent (208) of those 406 were given any preventive treatments.
An even lower number — 42 per cent (172) of the 406 — received the preventive treatments in accordance with international guidelines.
Preventing VTE can be achieved by various means, including limb movement — as advised on airline flights — compression stockings or anti-clotting drugs.
Gallus said while the latest guidelines were ‘‘ evolutionary’’ rather than dramatically different from previous versions, the evidence for the risk in medical patients had become much more concrete in recent years. This made it vital that the guidelines were properly applied, he said.
‘‘ Unless you have a mechanism that is part of the hospital system that includes the risk assessment, people (on hospital staff) won’t necessarily do it,’’ he said.
‘‘ And if they don’t do it, they will either apply prophylaxis in an indiscriminate way, and use it when it’s not needed as well as not use it when it is, or they won’t use it at all.
‘‘ Unless you build that (assessment) into the system, it just doesn’t work well.’’
The Lancet study was funded by drug giant Sanofi-Aventis, which makes one of the drugs used to prevent and treat VTE. However, Gallus said many of the older anticoagulant drugs were relatively cheap — costing about $1 per day — and in repeated studies had been shown to be cost-effective.
Gallus said the issue was important, but it had to be remembered that while pulmonary emboli were responsible for up to 10 per cent of hospital deaths, many of these patients were seriously ill with cancer or other diseases and preventing the clot would not meaningfully extend their lives.
‘‘ It’s not going to be 5 or 10 per cent of deaths that you prevent (by preventing VTE),’’ he said. ‘‘ But it might be 1 or 2 per cent of deaths that you prevent, which is still a large number across the nation.’’