Venous thromboembolism and pulmonary embolism Venous Thromboembolism and Pulmonary Embolism: The Forgotten High Risk Disease

Venous Thromboembolism (VTE) is a major cause of death which can be forgotten by many clinicians. ‘We are not good at diagnosing VTE before or after death’, said Professor David Fitzmaurice (Birmingham, UK). The risks of VTE are also not well known to patients except in relation to air travel. VTE is the leading cause of cardiovascular mortality after coronary heart disease and stroke. It kills more people in the UK than HIV, breast cancer, prostate cancer and road traffic accidents put together. However effective preventive strategies such as compression stockings and low molecular weight heparin (LMWH) can reduce the morbidity and mortality associated with this important disease. Randomised controlled trials such as MEDENOX, PREVENT and ARTEMIS have shown that prophylaxis with blood thinning agents is effective in reducing the risk of VTE without a significant increased bleeding risk.

The American College of Chest Physicians and others have published clear guidelines which advocate the widespread use of LMWH in VTE prevention. There has been a decrease in VTE in surgical patients in the past 40 years but this has not been seen for medical patients who make up over 60% of hospital admissions. The ENDORSE study was a multinational cross-sectional survey which examine patients in hospital wards in 32 countries and assessed which patients were at risk of VTE and which patients were receiving VTE prophylaxis. Fifty two per cent of patients were at risk of VTE but only 50% of those at risk were receiving appropriate treatment demonstrating the underuse of evidence based treatments to prevent clots across the world. All patients admitted to hospital in the UK should now undergo a VTE risk assessment and payment to hospitals is partly based on reaching a target of 90% of patients being risk assessed.

Professor Fitzmaurice emphasised the role of primary care in having an increased index of suspicion for VTE, educating patients about the importance of risk assessment, ensuring implementation of extended thromboprophylaxis (e.g. following hip of knee surgery) and a potential future role of carrying out risk assessment in the community. 

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