NICE guidelines urge hospitals to check for blood clots
Blood clots are a major cause of long-term illness, and death. Last year more than 56,000 people, or about 1,000 a week, were diagnosed with blood clots in their legs or lungs. Sadly, many of these will have been diagnosed after death. In some areas, the problem is not diagnosed quickly enough and people may have to wait over a weekend before they can get access to diagnostic scans.
NICE (The National Institute for Health and Clinical Excellence) has just issued new guidance to help bring these figures down. Their advice lays out clearly the combination of tests and treatments that are most effective at diagnosing and managing venous thromboembolic (VTE) diseases that include deep vein thrombosis (DVT) in the legs and pulmonary embolism (PE). They are urging hospitals in England and Wales to offer tests within 24 hours of identifying possible symptoms.
“Whether hospital-acquired or community-acquired, blood clots in the leg or lung can have the same devastating consequences. Their prevention in people who are admitted to hospital has quite rightly become a priority for the NHS in recent years,” said Professor Mark Baker, Director of the Centre for Clinical Practice at NICE.
“But despite progress in this area, particularly following the publication of the 2010 NICE guideline, every year thousands of people die in the UK as a result of a blood clot. Early diagnosis and appropriate management improves outcomes but is sometimes more difficult to achieve than might be imagined. For example, the treatment for a blood clot in the leg or the lung, once a diagnosis has been confirmed, is itself not without risk since anticoagulants and thrombolytic drugs can cause serious bleeding in some patients.
“This new guideline, based on a review of the most up-to-date research, clarifies what combination of tests and treatments are most clinically and cost effective in reducing the unacceptable toll of long-term ill health or even death from blood clots.”
Blood clots can be caused in a variety of ways. If your movement is really restricted, or you are much less active than normal following an operation or injury, for instance, your blood flow can slow down. This increases the risk of blood clots. Often these may develop while you are in hospital but can also develop after a journey of eight hours or more. You can also be at increased risk if you have heart and lung disease or inflammatory diseases such as rheumatoid arthritis, if you’re a smoker, are obese, over 60 or on HRT.
Cancer is another condition that increases your risk of developing blood clots. This new guideline is the first to recommend that people over 40 who are found to have a blood clot in either a leg or lung should be tested for cancer.
Susan Ballard, patient and carer representative on the Guideline Development Group, said: “These guidelines are important as they ensure that all patients who may have DVT or PE get access to prompt diagnosis and possibly life-saving treatments and, in those with DVT, follow-up to improve quality of life in terms of interventions to reduce post-thrombotic syndrome.
You don’t always have symptoms with a DVT, but you may be aware of some or all of these signs:
- Tenderness and swelling in your calf
- Skin that is red and feels hot (especially at the back of your calf)
If you have a pulmonary embolism, you may suddenly feel pain in your chest, which feels worse when you take a deep breath.
Both conditions are serious, so if you feel that you, or anyone with you may be affected, get medical help quickly.
Before you travel
If you are going on a long journey by air, or coach, where your movement will be restricted, it might be advisable to wear compression stockings, or flight socks, particularly if you are at increased risk of blood clots. Talk to your GP, and ask your pharmacist for advice before you buying, as it’s important that they fit well. You may find this article on NHS Choices website useful.