New standard of care aims to prevent deaths caused by largely preventable blood clots

Oct 12 2018

A new nationally agreed standard of care released today (Thursday) aims to reduce the tens of thousands of Australian lives put at risk each year by largely preventable blood clots, which kill four times more people than road accidents.

Each year 30,000 Australians develop blood clots – known as venous thromboembolism (VTE) – in the deep veins of the leg (deep vein thrombosis) or in the lungs (pulmonary embolism), at a cost of $1.72 billion to the Australian health system.

Many of these cases develop during or following a hospital stay, and an estimated 5,000 people die each year as a result of hospital-acquired VTE. For those affected by pulmonary embolism, sudden death is the first symptom in almost 25% of cases.

To address this significant health threat, the Australian Commission on Safety and Quality in Health Care (the Commission) has developed the first national Venous Thromboembolism Prevention Clinical Care Standard.

To be launched today at The Alfred Hospital in Melbourne, the new standard, which was informed by leading clinical experts and consumers, translates international guidelines and other evidence into clinical practice to reduce avoidable death or disability caused by hospital-acquired VTE.

Blood clots account for an estimated 10% of all hospital deaths in Australia - yet they are considered to be largely preventable, with intervention reducing the incidence of VTE by up to 70% for both medical and surgical patients.

Associate Professor Amanda Walker, Clinical Director at the Commission, said that while illness, injury and surgery are associated with blood clot development, it is possible for anyone to develop VTE.

“This serious condition is largely avoidable with proper VTE prevention, so it is concerning that a recent Australian report found that fewer than half (44%) of clinical units surveyed assessed patients for their risk of developing VTE on admission to hospital,” said Associate Professor Walker.

“Of those who were assessed to be at risk, not all were offered VTE prevention. This clearly indicates that many patients who should be receiving preventative treatment for blood clots are not getting the care they need.”

Associate Professor Walker said the new standard offers guidance on appropriate blood clot prevention methods and the importance of ongoing care after the patient leaves hospital.

“We know that up to 60% of all VTE cases in Australia occur within 90 days of hospitalization, and it can happen to both medical and surgical patients. We can do better and the new standard aims to support clinicians and health services to deliver quality care to prevent blood clots in hospital and following discharge,” she said.

“In fact, the evidence suggests that appropriate use of VTE prevention methods is the top intervention hospitals can make to improve patient safety.”

Leading hematologist Associate Professor Huyen Tran, Head of Head of Hemostasis and Thrombosis Unit at The Alfred Hospital, said the standard will help close the gap between guideline recommendations and practice and procedures in the hospital setting.

It’s clear that we can reduce the rate of blood clots significantly through timely assessments that are documented and discussed with the patient, and appropriate use of prevention methods such as medicine, during and after discharge from hospital,”

said Associate Professor Tran.

“It is shocking to consider that patients who have been admitted to hospital are at 100 times greater risk of developing a blood clot. This is a little known killer but one of the biggest preventable health threats facing Australians.”

Associate Professor Tran explained there are often signs that can indicate a person may be at risk of blood clots. “Patients who have symptoms like pain, tenderness or swelling of the leg, shortness of breath, coughing up blood or chest pain after a hospital stay should speak to their doctor about their concerns.

“Improved uptake of appropriate clot prevention strategies will help reduce the impact – on both patients and the health system.”

Patients with a hospital-acquired VTE remain in hospital for 21 days longer on average and each hospitalization costs about $45,000 extra, excluding loss of productivity and efficiency costs.

Be vigilant about this silent killer: Dr Feelgood

Dr Sally Cockburn, GP and health advocate, also known as radio’s ‘Dr Feelgood’, has personal experience with a dangerous blood clot. In May she suddenly collapsed at home when a clot in a vein moved to block her lung causing a pulmonary embolism.

“It’s hard to fathom that blood clots kill more patients in Australian hospitals each year than car accidents, but many people don’t even know what to look out for. We need to change the system so that more people don’t die unnecessarily,” said Dr Cockburn.

“Many people don’t realize they have a blood clot in a vein. It may not be until after a clot breaks off and the blood supply to the lungs becomes blocked that signs are noticed. Mine was a close brush with death and I want others to learn the warning signs.

“Australians need to be vigilant about the risk factors for blood clots and know the signs and symptoms. They should talk to their doctor about their medical conditions and medicines they are taking, and also ask questions about what will be done in hospital to reduce their risk of blood clots.”

The new clinical care standard has been endorsed by the Thrombosis and Hemostasis Society of Australia and New Zealand, the Royal Australasian College of Surgeons, the Australian Orthopedic Association, the Australian College for Emergency Medicine and other professional bodies.