Featured Research

from universities, journals, and other organizations

Studies Assess Blood Clot Prevalence Outside Hospital, Prevention In Hospital

Date:
July 31, 2007
Source:
JAMA and Archives Journals
Summary:
More cases of venous thromboembolism are diagnosed in the three months following hospitalization than during hospitalization, but less than half of inpatients receive medications to prevent blood clots from occurring, according to a recent article. A meta-analysis of previous studies finds that both unfractionated and low-molecular-weight heparin are effective in preventing blood clots in the legs and lungs of hospitalized patients.

More cases of venous thromboembolism are diagnosed in the three months following hospitalization than during hospitalization, but less than half of inpatients receive medications to prevent blood clots from occurring, according to a report in the July 23 issue of Archives of Internal Medicine.

A meta-analysis of previous studies published in the same issue finds that both unfractionated and low-molecular-weight heparin are effective in preventing blood clots in the legs and lungs of hospitalized patients.

Venous thromboembolism, which includes deep vein thrombosis (blood clot in the deep veins, such as of the legs and pelvis) and pulmonary embolism (clot that occurs in the lungs), is a major cause of complications and death in hospitalized patients, according to background information in the articles. As many as 10 percent of hospital deaths can be attributed to pulmonary embolism. However, previous studies suggest most cases of venous thromboembolism occur out of the hospital.

Frederick A. Spencer, M.D., of McMaster University Medical Center, Hamilton, Ontario, Canada, and colleagues analyzed the medical records of residents from the Worcester, Mass., metropolitan area who were diagnosed with venous thromboembolism during 1999, 2001 and 2003.

"A total of 1,897 subjects had a confirmed episode of venous thromboembolism," the authors write. "In all, 73.7 percent of patients developed venous thromboembolism in the outpatient setting; a substantial proportion of these had undergone surgery (23.1 percent) or hospitalization (36.8 percent) in the preceding three months." Among those patients, 67 percent experienced the condition within one month of their hospitalization. Other major risk factors included active cancer (29 percent) or a previous blood clot (19.9 percent).

Of the 516 patients with venous thromboembolism who had recently been hospitalized, three of five (59.7 percent) received any kind of therapy to prevent the condition while in the hospital. A total of 42.8 percent received anti-clotting medications and an addition 16.9 percent received only non-pharmaceutical prevention methods. "Because most of the cases of venous thromboembolism occurred within 29 days of hospital discharge (and 41 percent occurred within 14 days), it is not unreasonable to assume that some of these cases may have been prevented simply by increased use of appropriate in-hospital deep vein thrombosis prophylaxis (e.g., compression stockings, pneumatic compression devices and, in high-risk patients, anticoagulants)," the authors write.

"Approximately half of the outpatients who experienced venous thromboembolism following hospitalization had a length of stay that was four days or less," they continue. This suggests that patients in the hospital for a short time also should be given preventive therapy. In addition, because the length of hospital stays is decreasing overall, patients may spend more time immobilized at home and therefore may benefit from anti-clotting therapy even after discharge.

In a related paper, Lironne Wein of Monash University and Alfred Hospital, Melbourne, Australia, and colleagues conducted a meta-analysis of previously published randomized controlled trials, all of which compared medications used to prevent venous thromboembolism with each other or with a control group of patients who did not receive prophylactic (preventive) therapy. Thirty-six studies published before June 2006 were included. Fourteen of them compared the drug unfractionated heparin with a control, 11 compared low-molecular-weight heparin to a control, 10 compared the two types of heparin to each other and one compared a drug known as fondaparinux sodium with placebo.

Compared with control groups, unfractionated heparin was associated with a 67 percent lower risk of deep vein thrombosis and a 36 percent lower risk of pulmonary embolism, while low-molecular-weight heparin was associated with a 44 percent lower risk of deep vein thrombosis and 63 percent lower risk of pulmonary embolism.

When the drugs were compared with each other, low-molecular-weight heparin was associated with a 32 percent lower risk of deep vein thrombosis and a 53 percent lower rate of hematoma [localized bleeding into or beneath the skin] at the injection site. However, prophylactic therapy was not associated with reduced mortality rates. Fondaparinux sodium was also effective in the prevention of venous thromboembolism.

"This meta-analysis has shown that unfractionated heparin and low-molecular-weight heparin are both associated with a reduced risk of venous thromboembolism in medical patients, with low-molecular-weight heparin being more effective in preventing deep vein thrombosis than unfractionated heparin when considering trials that directly compared the two agents," the authors write. "The unfractionated heparin dosage of 5,000 units three times daily was more effective than the unfractionated heparin dosage of 5,000 units twice daily in reducing the risk of deep vein thrombosis."

"We believe that routine prophylactic anticoagulation has an important place in the medical setting," they conclude. "Although such therapy may not necessarily decrease mortality among hospitalized medical patients, it will reduce the occurrence of deep vein thrombosis and pulmonary embolism and therefore the burden of illness currently caused by these events."

Reference: Arch Intern Med. 2007;167(14):1471-1475 and 1476-1486.

Editorial: Venous Thromboembolism a Common but Preventable Threat

Venous thromboembolism is a common public health threat, but can be prevented if at-risk patients are targeted for preventive therapy and barriers between inpatient and outpatient care are removed, writes Samuel Z. Goldhaber, M.D., of Brigham and Women's Hospital, Boston, in an accompanying editorial.

"I predict that preventing outpatient venous thromboembolism will be the 'hot button' issue in 2008," Dr. Goldhaber writes. "We must start collecting relevant data at the time of hospital discharge so that we can provide these vulnerable patients with proper and comprehensive venous thromboembolism prophylaxis. Recognizing the public health threat of outpatient venous thromboembolism and breaking down artificial barriers between outpatient and inpatient venous thromboembolism prophylaxis are vital first steps."

Reference for editorial: Arch Intern Med. 2007;167(14):1451-1452.


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Cite This Page:

JAMA and Archives Journals. "Studies Assess Blood Clot Prevalence Outside Hospital, Prevention In Hospital." ScienceDaily. ScienceDaily, 31 July 2007. <www.sciencedaily.com/releases/2007/07/070723163555.htm>.
JAMA and Archives Journals. (2007, July 31). Studies Assess Blood Clot Prevalence Outside Hospital, Prevention In Hospital. ScienceDaily. Retrieved July 31, 2014 from www.sciencedaily.com/releases/2007/07/070723163555.htm
JAMA and Archives Journals. "Studies Assess Blood Clot Prevalence Outside Hospital, Prevention In Hospital." ScienceDaily. www.sciencedaily.com/releases/2007/07/070723163555.htm (accessed July 31, 2014).

Share This




More Health & Medicine News

Thursday, July 31, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Concern Grows Over Worsening Ebola Crisis

Concern Grows Over Worsening Ebola Crisis

AFP (July 30, 2014) Pan-African airline ASKY has suspended all flights to and from the capitals of Liberia and Sierra Leone amid the worsening Ebola health crisis, which has so far caused 672 deaths in Guinea, Liberia and Sierra Leone. Duration: 00:43 Video provided by AFP
Powered by NewsLook.com
At Least 20 Chikungunya Cases in New Jersey

At Least 20 Chikungunya Cases in New Jersey

AP (July 30, 2014) At least 20 New Jersey residents have tested positive for chikungunya, a mosquito-borne virus that has spread through the Caribbean. (July 30) Video provided by AP
Powered by NewsLook.com
Xtreme Eating: Your Daily Caloric Intake All On One Plate

Xtreme Eating: Your Daily Caloric Intake All On One Plate

Newsy (July 30, 2014) The Center for Science in the Public Interest released its 2014 list of single meals with whopping calorie counts. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

    Environment News

    Technology News



      Save/Print:
      Share:

      Free Subscriptions


      Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

      Get Social & Mobile


      Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

      Have Feedback?


      Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
      Mobile: iPhone Android Web
      Follow: Facebook Twitter Google+
      Subscribe: RSS Feeds Email Newsletters
      Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins