Decrease the Risk of Blood Clots During Hospital Stays

Every year, approximately 2 million Americans are affected by deep vein thrombosis (DVT), a blood clot in the thigh or leg. Approximately 600,000 experience pulmonary embolism (PE). For up to 200,000 of those with PE, the blood clot in the lung proves fatal -- almost twice as many deaths per year as AIDS, breast cancer, and highway fatalities combined. Older adults and those in the hospital are at increased risk for deep vein thrombosis (DVT).

Here are some of the factors that put hospital patients at risk of DVT:

• Increasing age
• Cancer and its treatment
• Cardiac dysfunction
• Chronic respiratory failure
• Major surgery (abdomen, pelvis, lower extremities)
• Trauma (fracture of the pelvis, hip or leg)
• Prior DVT blood clot
• Prolonged immobility, stroke, or paralysis
• Varicose veins
• Indwelling central venous catheter

There are ways to decrease the rate of such blood clots among elderly patients, according to a report in the Archives of Internal Medicine, one of the JAMA/Archives journals.

Medications, usually blood thinners, and compression stockings have been shown to reduce or prevent DVT in some patients. The inconvenience of the stockings (they can be expensive, hot and hard to put on), means they are not widely used. As a result, several studies show a gap between scientific recommendation and clinical practice in post–acute care facilities, according to the article's authors. Post–acute care facilities are used to ease the transition between short hospital stays and home when patients require special care or rehabilitation.

Simple reminders are the key

So why the gap between medical theory and reality? Why aren't care givers in post–acute care facilities implementing these simple measures to prevent DVT?

One study says it comes down to education and awareness. Elodie Sellier, M.D. at Joseph Fourier University in Grenoble, France, and colleagues studied 1,373 patients age 65 or older (66.9 percent women) enrolled in 33 post–acute care facilities in France. The researchers evaluated patients for DVT before and after they implemented guidelines for preventing DVT for physicians and nurses.

The guidelines recommended that health care providers give preventive medications to certain patients, such as those who recently had major surgery or who previously had DVT. Physical therapy, compression stockings, and other non-drug preventive measures were recommended for other patients, or in addition to medications in some cases.

The facilities held sessions to communicate the guidelines, and gave physicians and nurses posters and plastic cards as reminders. The researchers assessed 709 patients before and 664 patients following the implementation of the guidelines.

Before the guidelines were put in place, a blood clot was found in 12.8% (91 of 709) patients. Following the intervention, clots were found in only 7.8% (52 of 664) patients. The post-intervention participants were more likely to use compression stockings and less likely to take medications that were not recommended by the guidelines, especially if they were patients for whom drug therapy was not recommended under the guidelines.

The most important factor in the drop in the rate of DVT prevention was the increased use of graduated compression stockings, while the change in the use of medication was modest, according to the authors of the JAMA article.