Preventing blood clots & deep vein thrombosis in hospitals

Lesley Dobson

When you're in hospital for surgery, ask for a blood clot risk assessment if it's not done automatically.



Blood clots are responsible for more deaths in hospital each year than superbugs, according to tthe annual Dr Foster Hospital Guide.

NHS hospital trusts in England reported more than 30,500 life-threatening blood clots but, say the guide’s authors, the real figure is likely to be considerably higher as not all blood clots are recorded as such because of the hospitals’ coding rules.

The report states that many patients with a type of blood clot called a Pulmonary Embolism (PE), were instead recorded as having had unspecified complications caused by their treatment. "Blood clots kill more people than superbugs every year," said Roger Taylor, Director of Research at Dr Foster. "Yet the reporting of blood clots is just not always sufficient to identify and address the problem."

Risk assessment

At the beginning of March this year, the Department of Health issued guidance on risk assessment for venous thromboembolism (VTE; PE is a type of venous thromboembolism ), stating that all patients should have their risk assessed when being admitted to hospital, again 24 hours later, and whenever their clinical situation changed.

The process includes assessing all patients for mobility, and for thrombosis risk and bleeding risk. Only six hospital trusts said that they assessed 100 percent of their patients for VTEs.

"I know that blood clots are a much bigger risk than hospital acquired infections," said Professor Beverley Hunt, consultant haematologist at St Thomas’ NHS Foundation Trust in London. "It’s estimated that without preventive measures, there would be about 25,000 deaths per annum from blood clots in the UK.

"Each trust is obligated to risk-assess all adult patients who go into their hospitals. If they don’t, they can be fined."

Government response

Prime Minister David Cameron’s response to a question in the House of Commons indicated that the government is looking at the situation. "The first thing to do is to make available more information," he said.

"You shouldn’t go into hospital and expect the risk of getting a blood clot," said Professor Hunt. "Just as you shouldn’t expect to get a hospital acquired infection. 70 percent are preventable with blood thinners and stockings.

"The average DVT occurs about seven days after an operation. The average PE happens around 21 days after an operation," she said. "The length of stay in hospital is generally very short, so you’re going home and then developing a blood clot."

Until NHS Hospital trusts carry out risk assessments as a matter of course, what can you do to reduce your risk of developing a blood clot? To start with, ask the hospital staff if they have carried out a risk assessment for VTE. If they haven’t, ask them to do one as soon as they can, and to repeat it within 24 hours.

Being aware of the risk factors for a blood clot can also help you have some idea of your own risk.

Potential risk factors, include:

  • growing older
  • you or a member of your family having had a blood clot before
  • having had a heart attack or stroke before
  • being immobile for long periods
  • having high blood pressure
  • smoking
  • having high cholesterol levels
  • undergoing an operation on the lower part of your body

You can have a blood clot yet have no symptoms, which is why being aware of your risk factors is so important. However there are some symptoms that are useful to know about. If you have a venous thrombosis for instance, you may have a heavy ache in the area, pain, swelling and redness, or an itchy rash around the area of the clot. A deep vein thrombosis (DVT) can cause a blue or red/purplish look to the skin on the affected leg. With a pulmonary embolism (PE) you may feel breathless and have chest pain.

Blood clots explained

Venous thrombosis

This is when a blood clot (also known as a thrombus) forms in a vein.

Deep vein thrombosis (DVT)

This is a blood clot that forms in the deep veins in the legs, thighs or pelvis.

Pulmonary embolism

This is a blood clot that breaks off from a deep vein and travels in the blood to block the arteries in the lung (pulmonary arteries).

Venous thromboembolism (VTE)

This is when a blood clot breaks away from its original site and blocks a blood vessel. Both PEs and DVTs come under the heading of venous thromboembolism





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