GPs’ role in preventing VTE in surgical patients

3 Nov 2014 | Safe Surgery NZ

Blood clots and YOU is a new venous thromboembolism (VTE) brochure developed by Southern Cross Hospitals as a resource for GPs to share and discuss with patients going on to surgery.

Few patients are aware that they are more at risk of developing a VTE or blood clot after surgery than they are when they take a long-haul flight. GPs can make a vital contribution to preventing VTE by providing information and advice about VTE risk to patients referred for surgery.

VTE describes a combination of the formation of a thrombus in a vein or veins, usually in the legs or pelvis, and the embolisation of the thrombus to the pulmonary arterial system via the inferior vena cava and right heart chambers.

The most common clinical presentation of VTE is as a deep venous thrombosis (DVT), but it may present as a pulmonary embolism (PE). About one in ten patients experiencing a PE will die as a result of their PE.[1] [2] The June 2014 Perioperative Mortality Review Committee report showed a PE-associated mortality rate of 8.7 per 100,000 patients who underwent an elective or waiting list procedure. That’s about one death from PE in every 11,500 procedures.

The Blood clots and YOU brochure gives patients lists of risk factors, actions that can be taken to reduce the risk of blood clots, and signs to watch out for. It also includes a simple post-operative recovery plan.

The brochure was developed with funding from the Health Quality & Safety Commission and Southern Cross Hospitals Limited. Preventing VTE is part of the Commission’s ongoing Reducing Perioperative Harm programme. The national patient safety campaign, Open for better care, promotes VTE risk assessments for all patients having surgery.

The risk of VTE increases tenfold in patients admitted to hospital, with contributing factors including general ill health or comorbidities, reduced mobility, smoking, and poor fluid intake. Major surgical procedures (particularly orthopaedic and other high-risk surgeries) are further risk factors – however, patients who had short or minor procedures have also developed fatal PE, so no patient is automatically excluded from risk of VTE. The Blood clots and YOU brochure has been designed using patient research so patients can be more effectively engaged in self-care and know when they must seek prompt medical attention.

Preventing VTE in hospital patients is widely recognised internationally as a major opportunity to improve patient safety. A retrospective study at a large New Zealand hospital showed that 106 patients were harmed by hospital-associated VTE in 2008. In the same hospital, data collected over 2010 and 2011 found that more than 150 patients per year developed hospital-associated VTE.[3]

If these figures are extrapolated across the 20 district health boards (DHBs), they suggest more than 1500 patients a year may develop hospital-associated VTE. Morbidity from VTE for survivors and the resulting costs to the health care system can be substantial.

In a broad range of patients, effective VTE prevention techniques, such as drinking a recommended amount of water, keeping active, wearing compression stockings, appropriate medication in consultation with a surgeon, and mechanical prophylaxis techniques, can reduce the risk of DVT and both fatal and non-fatal PE by more than 60 percent.[4]

The brochure can be downloaded at: http://hospitals.southerncross.co.nz/patient-information/patient-forms-leaflets.aspx and patients can find more detailed information at: http://hospitals.southerncross.co.nz/patient-information/blood-clots.aspx.

Comments are welcome in the feedback box at the end of Blood clots and YOU webpage.

For more detailed information for health professionals see the NZ VTE Prevention Steering Group’s National policy framework: VTE prevention in adult hospitalised patients in NZ. June 2012. http://www.hqsc.govt.nz/assets/Other-Topics/QS-challenge-reports/VTE-Prevention-programme-National-Policy-Framework.pdf.

References:

  1. MacDougall DA, Feliu AL, Boccuzzi SJ, Lin J. Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome. Am J Health Syst Pharm. 2006;63(20 Suppl 6):S5-15.
  2. Matsumoto AH, Tegtmeyer CJ. Contemporary diagnostic approaches to acute pulmonary emboli. Radiol Clin North Am. 1995;33(1):167-83.
  3. Haematology Department, Counties Manukau District Health Board. Retrospective evaluation of hospital-acquired VTE rates at CMDHB. (Unpublished report). 2008.
  4. Geerts W. Prevention of venous thromboembolism: a key patient safety priority. J Thromb Haemost. 2009;7(1):1-8.

Last updated 03/11/2014