Primarily occurring in the legs, Deep vein thrombosis (DVT) is the potentially life threatening development of a blood clot in a deep vein.
Using prophylaxis for DVT is neither complicated nor expensive. In fact, several studies show that preventing this disease is cheaper than treating its consequences. Giving prophylaxis to those who are at risk should be a routine practice. The keys to preventing DVT are in knowing who is at risk, when to apply the preventive measure, and applying the appropriate measure.
When a blood clot travels to the lungs it creates a potentially life threatening condition known as pulmonary embolism. This happens when a part of the clot seperates and moves its way up to the lungs. Together, pulmonary embolism and DVT constitute a single disease process known as venous thromboemolism VTE.
Symptoms or signs of DVT may include detention of surface veins, discoloration, pain, redness, swelling, or warmth. Typically half of all patients that have DVT show no symptoms. Signs and symptoms alone are not specific or sensitive enough to make a diagnosis.
Common prevention practices utilize intermittent pneumatic compression or graduated compression socks. Different preventative measures are used depending on the patient’s risk for DVT. Leg muscle contractions pump blood towards the heart help to compress the veins. Walking and calf exercises help increase blood flow in the legs reducing venous stasis. Immobile patients can utilize physical compression, as described above, as methods to improve blood flow.
Risk of Death
“DVT kills more people every year than AIDS, breast cancer, and motor vehicle accidents combined,” says Geno J. Merli, MD, Director of Internal Medicine at Jefferson Medical College in Philadelphia. “Most patients, and even many physicians, don’t realize that.”
Each year, 600,000 patients will experience venous thromboembolism. Every year, some where between 50,000 and 200,000 patients will die from blood clots that obstruct blood flow to their lungs (pulmonary embolism).
The tragedy is that most of these problems could be avoided by simple, cost-effective measures. Use of modern methods of DVT prophylaxis will reduce the incidence of DVT during the postoperative period by two-thirds and will prevent death from pulmonary embolism in 1 patient out of every 200 major operations.
Major orthopedic surgery—total hip replacement, total knee replacement, or hip fracture surgery—has a high risk of causing VTE. Special care should be taken after surgery. Mechanical prophylaxis such as intermittent pneumatic compression or a graduated compression stocking can be used to reduce the risk. Certain patients will find themselves at greater risk than others.
Patient Risk Factors
- History of venous thromboembolism (VTE)
- Varicose veins
- Malignant disease
- Severe infection
- Chronic renafl Failure
- More than three pregnancies
- Inflammatory bowel disease
- Hormone replacement therapy
- Oral contraceptive use
Strong family history of clotting complications should be inquired about and may also influence prophylactic treatment strategy.
Initial DVT costs for an average hospitalized patient in the U.S. are around $7,700–$10,800. VTE follow-up costs at three months, six months and a year are about $5,000 $10,000 and $33,000 respectively. Post-thrombotic syndrome is a significant contributor to DVT follow-up costs. Annual DVT costs in the U.S. are estimated from $5 billion to in excess of $8 billion. The average annual cost per treated individual is thought to be about $20,000. As an example, if 300,000 symptomatic DVT patients were treated at costs averaging $20,000 annually that would cost $6 billion a year.