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Senior Citizen Health & Medicine
Blood Clots Likely to Occur After Leaving Hospital
Due to Lack of Inpatient Care
Preventing outpatient blood clots may be the 'hot
button' issue in 2008
July 23, 2007 - More cases of venous
thromboembolism (blockage of blood vessel by blood clot) are diagnosed
in the three months following hospitalization than during
hospitalization, but less than half of inpatients receive medications to
prevent these blood clots from occurring, according to a report in the
July 23 issue of Archives of Internal Medicine, one of the JAMA/Archives
journals. It may be assumed that most of these patients are senior
citizens, whom are the most likely to be hospitalized.
A meta-analysis of previous studies published in
the same issue finds that both unfractionated (not divided or separated
into parts) and low-molecular-weight heparin are effective in preventing
blood clots in the legs and lungs of hospitalized patients.
Heparin is a medication to thin blood, which helps
prevent blood clots from forming.
Venous thromboembolism, which includes deep vein
thrombosis (blood clot in the deep veins, such as of the legs and
pelvis) and pulmonary embolism (clot that occurs in the lungs), is a
major cause of complications and death in hospitalized patients,
according to background information in the articles.
As many as 10 percent of hospital deaths can be
attributed to pulmonary embolism. However, previous studies suggest most
cases of venous thromboembolism occur out of the hospital.
Frederick A. Spencer, M.D., of McMaster University
Medical Center, Hamilton, Ontario, Canada, and colleagues analyzed the
medical records of residents from the Worcester, Mass., metropolitan
area who were diagnosed with venous thromboembolism during 1999, 2001
and 2003.
"A total of 1,897 subjects had a confirmed episode
of venous thromboembolism," the authors write.
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Recent Related Research |
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Nearly one-third U.S. Hospital Patients at
Risk of Venous Thrombosis
A study released earlier this month found
venous thrombosis (VTE), the formation of blood clots in a vein,
is a major health problem for hospitalized patients in the
United States. Our findings suggest that each year, almost
one-third of hospitalized patients are at risk of VTE, notes
the studys lead author, Dr. Frederick Anderson.
This highlights the magnitude of the US
public health risk posed by this potentially preventable
condition. This study by researchers at the University of
Massachusetts Medical School and Mayo Clinic College of Medicine
was published online in the American Journal of Hematology.
The study found In total, more than 12
million of the approximately 38 million patients discharged from
US hospitals in 2003 were at risk of VTE during their hospital
stay based on the standard ACCP criteria. Dr. Anderson and his
associates speculate that at least half of hospitalized patients
at risk for VTE receive no preventative care, and countless
suffer the consequence of serious complications, including
premature death.
The risk is highest for people undergoing
orthopedic surgery, such as hip or knee replacement, Anderson
told Health Day News. "About 9 of every 10 orthopedic surgery
patients are at risk," he said.
25,000 needless
deaths annually in UK due to failure to tackle blood clots in
hospital
Up to 25,000 people may die needlessly
each year due to the failure to prevent blood clots known as
venous thromboembolisms (VTE) in UK hospitals, say experts in a
May issue of BMJ.
Their warning follows the publication of
official guidelines on the issue last month by the National
Institute for Health and Clinical Excellence (NICE), which are
also summarised in this week's journal.
It is estimated that VTE kills around
60,000 people every year in the UK and the condition accounts
for 10% of all hospital deaths, write David Fitzmaurice and
Ellen Murphy from the University of Birmingham. This is 10 times
greater than deaths due to MRSA and five times more deaths than
breast cancer, AIDS and road traffic accidents combined.
People who have recently had surgery are
particularly at risk.
Trials show that drugs can reduce the
rate of VTE by up to 65%, yet a Health Select Committee report
in 2005 found that only one in five patients at risk were
getting them. |
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"In all, 73.7 percent of patients developed venous
thromboembolism in the outpatient setting; a substantial proportion of
these had undergone surgery (23.1 percent) or hospitalization (36.8
percent) in the preceding three months."
Among those patients, 67 percent experienced the
condition within one month of their hospitalization. Other major risk
factors included active cancer (29 percent) or a previous blood clot
(19.9 percent).
Of the 516 patients with venous thromboembolism who
had recently been hospitalized, three of five (59.7 percent) received
any kind of therapy to prevent the condition while in the hospital.
A total of 42.8 percent received anti-clotting
medications and an additional 16.9 percent received only
non-pharmaceutical prevention methods.
"Because most of the cases of venous
thromboembolism occurred within 29 days of hospital discharge (and 41
percent occurred within 14 days), it is not unreasonable to assume that
some of these cases may have been prevented simply by increased use of
appropriate in-hospital deep vein thrombosis prophylaxis (e.g.,
compression stockings, pneumatic compression devices and, in high-risk
patients, anticoagulants)," the authors write.
"Approximately half of the outpatients who
experienced venous thromboembolism following hospitalization had a
length of stay that was four days or less," they continue.
This suggests that patients in the hospital for a
short time also should be given preventive therapy. In addition, because
the length of hospital stays is decreasing overall, patients may spend
more time immobilized at home and therefore may benefit from
anti-clotting therapy even after discharge.
In a related paper, Lironne Wein of Monash
University and Alfred Hospital, Melbourne, Australia, and colleagues
conducted a meta-analysis of previously published randomized controlled
trials, all of which compared medications used to prevent venous
thromboembolism with each other or with a control group of patients who
did not receive prophylactic (preventive) therapy.
Thirty-six studies published before June 2006 were
included. Fourteen of them compared the drug unfractionated heparin with
a control, 11 compared low-molecular-weight heparin to a control, 10
compared the two types of heparin to each other and one compared a drug
known as fondaparinux sodium with placebo.
Compared with control groups, unfractionated
heparin was associated with a 67 percent lower risk of deep vein
thrombosis and a 36 percent lower risk of pulmonary embolism, while
low-molecular-weight heparin was associated with a 44 percent lower risk
of deep vein thrombosis and 63 percent lower risk of pulmonary embolism.
When the drugs were compared with each other,
low-molecular-weight heparin was associated with a 32 percent lower risk
of deep vein thrombosis and a 53 percent lower rate of hematoma
[localized bleeding into or beneath the skin] at the injection site.
However, prophylactic therapy was not associated
with reduced mortality rates. Fondaparinux sodium was also effective in
the prevention of venous thromboembolism.
"This meta-analysis has shown that unfractionated
heparin and low-molecular-weight heparin are both associated with a
reduced risk of venous thromboembolism in medical patients, with
low-molecular-weight heparin being more effective in preventing deep
vein thrombosis than unfractionated heparin when considering trials that
directly compared the two agents," the authors write.
"The unfractionated heparin dosage of 5,000 units
three times daily was more effective than the unfractionated heparin
dosage of 5,000 units twice daily in reducing the risk of deep vein
thrombosis."
"We believe that routine prophylactic
anticoagulation has an important place in the medical setting," they
conclude. "Although such therapy may not necessarily decrease mortality
among hospitalized medical patients, it will reduce the occurrence of
deep vein thrombosis and pulmonary embolism and therefore the burden of
illness currently caused by these events."
Editorial: Venous Thromboembolism a Common but
Preventable Threat
Venous thromboembolism is a common public health
threat, but can be prevented if at-risk patients are targeted for
preventive therapy and barriers between inpatient and outpatient care
are removed, writes Samuel Z. Goldhaber, M.D., of Brigham and Women's
Hospital, Boston, in an accompanying editorial.
"I predict that preventing outpatient venous
thromboembolism will be the 'hot button' issue in 2008," Dr. Goldhaber
writes.
"We must start collecting relevant data at the time
of hospital discharge so that we can provide these vulnerable patients
with proper and comprehensive venous thromboembolism prophylaxis.
Recognizing the public health threat of outpatient venous
thromboembolism and breaking down artificial barriers between outpatient
and inpatient venous thromboembolism prophylaxis are vital first steps."
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