Annual direct medical costs for VTE total between $5 billion and $8 billion, not including care for long-term complications, according to the CDC.
Yet institutional culture blocks solutions.
Professional groups disagree on which patients are more likely to develop a clot, or which patients should be given prophylaxis such as blood thinners or mechanical interventions such as pneumatic compression sleeves or anti-embolic stockings, says Greg Maynard, MD, a VTE expert at the University of California San Diego.
Use of Maynard's "Three-Bucket Tool" has so precisely determined which patients should receive prophylaxis, and what kind, the number of preventable hospital-acquired VTE cases dropped at UCSD from 13 in the first quarter of 2005 to two in the first quarter of 2007, he says. Some hospitals that have adopted the tool, such as Banner Health in Phoenix, replicated those improvements, he says.
Even two leading professional organizations, the American College of Physicians and the American College of Chest Physicians, are in disagreement with others over which patients should be placed in high-risk categories.
Maynard likens trends in thinking to a swinging pendulum. Several years ago, "It probably was too far on the side that if someone's in the hospital, they should be on an anticoagulant. Now with new guidelines issued by professional organizations, the pendulum has gone too far in the opposite direction, especially for the medical inpatient."
What is needed is something in the middle, "to exclude people from getting anticoagulants who obviously don't need them, such as people who are ambulating or leaving the hospital the next day, and don't have a lot of risk factors."