DVT in hospitals: guideline implementation (page 1 of 6)
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Introduction
Deep vein thrombosis and pulmonary embolism co-exist as part of the thromboembolic disease process. In 1976, the mortality of recognised and treated pulmonary embolism was 8%.1 Despite increased awareness of this disease and changes in prevention, diagnosis and treatment there has been little improvement in the prognosis with recent registries reporting the mortality to be 7%.2
Sixty per cent of all patients diagnosed with DVT develop the condition during hospital admission for an unrelated illness and 10% of hospital deaths are caused by VTE.3 Whilst certain surgical procedures, such as major joint replacement, colorectal surgery and surgery for cancer, have long been associated with a high risk of VTE, recent studies have demonstrated that older medical patients hospitalised with acute illness have a comparable risk. In 2004 the American College of Chest Physicians (ACCP) stated that ‘PE is the most common preventable cause of hospital death and is the number one strategy to improve patient safety in hospitals’.4 Those patients who develop PE during hospital admission are not only at risk of death but also a prolonged hospital stay and anticoagulant therapy. Patients who develop DVT are at risk of PE (either in hospital or at home following discharge) as well as post-thrombotic syndrome of the affected leg.
There are several evidence-based guidelines for the prevention of VTE. These have been produced by specialty organisations such as Investigators Against Thromboembolism (INATE), and the ACCP as well as national organisations, for example the Scottish Intercollegiate Guideline Network (http://www.sign.ac.uk). Despite the publication of these guidelines, the use of VTE prophylaxis varies markedly.
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