Venous thromboembolism caused 25 000 deaths a year, say MPsBMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7491.559-c (Published 10 March 2005) Cite this as: BMJ 2005;330:559
Blood clots that develop while patients are in hospital cause deaths on a far larger scale than does methicillin resistant Staphylococcus aureus (MRSA), but the extent of the problem is largely unrecognised by doctors, MPs said this week.
In a critical report on the prevention of venous thromboembolism, the health select committee said the condition killed more than 25 000 patients in England each year, more than the combined deaths from breast cancer, AIDS, and road traffic injuries and more than 25 times the number of deaths from MRSA.
However, although many of the deaths from venous thromboembolism are preventable through cheap and effective drug treatment, problems often do not occur until after discharge from hospital, and so physicians and surgeons are left unaware of the problem.
MPs were shocked the situation had gone unchecked for so long and called for all patients to have their risk assessed on admission to hospital to determine if they needed preventive drug treatment.
Each hospital should establish a thrombosis team as soon as possible to promote best practice and educate and train staff, the report recommended.
Blood clots usually occur in the deep veins in the legs, thighs, or pelvis, and a problem arises if part or all of the clot breaks off and travels through the venous system. In the United Kingdom, pulmonary embolism after deep vein thrombosis is the immediate cause of death of a tenth of all patients who die in hospital.
The MPs' report cited a study of over 4000 patients who died of pulmonary embolism after major surgery; the study showed that the use of perioperative low dose heparin saved seven lives per 1000 patients operated on. The death rate is currently eight per 1000 operated on.
Despite the scale of the problem, doctors will have to wait until May 2007 for clinical guidelines on preventive measures from the National Institute for Clinical Excellence. These guidelines will apply only to surgical patients at high risk of venous thromboembolism.
The select committee condemned this response as “remarkably tardy.” It said: “Moreover, the scope of the guidelines commissioned by the Department of Health is limited to a subset of surgical patients, while the majority of sufferers are non-surgical patients.”
The committee's chairman, David Hinchliffe, said: “The guidelines are too late, too narrow in scope, and will not go far enough. Hospital staff and medics are simply not aware of the extent of venous thromboembolism. Doctors need a comprehensive set of guidelines that will cover all patients to allow them to tackle the problem head on.”
A Department of Health spokesperson said there were no plans to bring forward the publication of guidelines, but the wait shouldn't affect patients.
“Patients will continue to be treated who present with VTE [venous thromboembolism]—no one is waiting around until 2007. NICE guidance is not the start of the process, but an appraisal of the clinical and cost effectiveness of best practice in the NHS. There is currently a variety of treatment options available.”
The Prevention of Venous Thromboembolism in Hospitalised Patients is available at www.parliament.uk
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