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3/1/2004

Recognize Patients' Risks for Deep Vein Thrombosis

Cheryl A. Thompson

Deep vein thrombosis (DVT) and its deadly complication, pulmonary embolism, can be prevented in many more Americans than currently receive prophylaxis, according to the coalition of organizations sponsoring DVT Awareness Month in March 2004.

The Coalition to Prevent Deep-Vein Thrombosis has its roots in a February 2003 meeting convened in Washington, D.C., by the American Public Health Association and the Centers for Disease Control and Prevention. Attendees, representing several organizations, agreed to establish a coalition to educate the public and health care community about DVT and the importance of patients and clinicians recognizing risk factors for the condition and acting early to prevent its onset.

According to an epidemiological survey, only 42 percent of the 2,726 patients whose DVT was diagnosed while they were in the hospital had received preventive therapy at anytime in the 30 days before the diagnosis. The research, directed by the Council for Leadership on Thrombosis Awareness and Management and supported by Aventis Pharmaceuticals, was conducted at 183 U.S. sites and described in the Jan. 15 American Journal of Cardiology.

As part of the Coalition to Prevent Deep-Vein Thrombosis, ASHP urges health-system pharmacists to ensure their patients are routinely evaluated for their risk of DVT. The Society also urges pharmacists to ensure that patients at risk of DVT receive appropriate therapy to prevent its onset.

Cynthia L. LaCivita, Pharm.D., director of Clinical Standards and Quality in the ASHP Practice Standards and Quality Division, said pharmacists should verify that their hospital routinely assesses all patients for their risk of DVT. Also, pharmacists should ensure that, for patients needing preventive therapy with an anticoagulant, the medication regimen follows evidence-based guidelines developed by the hospital or an expert group, such as the American College of Chest Physicians (PDF).

The American Public Health Association sponsored the development of the white paper (PDF) "Deep-Vein Thrombosis: Advancing Awareness to Protect Patient Lives," which describes the frequency of DVT, its risk factors, barriers to prevention, and effective prophylaxis.

According to the white paper, the top risk factors and triggers for DVT are:

  • Increasing age,
  • Prolonged immobility,
  • Stroke,
  • Paralysis,
  • Previous venous thromboembolism,
  • Cancer and its treatment,
  • Major surgery, particularly operations on the abdomen, pelvis, and lower extremities,
  • Respiratory failure,
  • Trauma, particularly a fracture of the pelvis, hips, or leg,
  • Obesity,
  • Varicose veins,
  • Congestive heart failure and myocardial infarction,
  • Indwelling central venous catheter,
  • Inflammatory bowel disease,
  • Nephrotic syndrome,
  • Pregnancy or use of oral contraceptives or postmenopausal hormone therapy, and
  • Inherited predisposition for clotting.

ASHP is one of about 25 organizations in the coalition.

DVT Awareness Month is supported by an unrestricted educational grant from Aventis.