National Institute for Health and Clinical Excellence (NICE)
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New NICE guideline on blood clot prevention will help save thousands of lives

Thousands of lives could be saved with the help of a new guideline on preventing blood clots in hospital patients, published yesterday (Wednesday 27 January) by the National Institute for Health and Clinical Excellence (NICE).  The guideline focuses on reducing the risk of deep vein thrombosis (blood clots blocking veins, also commonly known as DVT) in patients admitted to hospital.  If a blood clot breaks away it may travel to the lungs and cause a blockage - a potentially fatal pulmonary embolism.   Venous thromboembolism (VTE) covers both DVT and its possible consequence pulmonary embolism - the guideline sets out simple steps to help prevent VTE and therefore help save lives.

An estimated 25,000 people who are admitted to hospital die from preventable venous thromboembolism each year.  The NICE guideline, jointly developed with the National Clinical Guideline Centre for Acute and Chronic Conditions, recommends that all patients should be assessed for risk of developing blood clots on admission to hospital, and then given preventative treatment that suits their individual needs. Options include blood-thinning drugs such as heparin, anti-embolism stockings and foot impulse or pneumatic devices.  Importantly, this advice covers all patients admitted to hospital - including those having day-case procedures - and not just those patients having surgery.

Professor Sir Liam Donaldson, Chief Medical Officer, said: “The Department of Health is prioritising the prevention of VTE across the NHS. NICE is internationally recognised for the quality of its guidance, so I am pleased to see this comprehensive and timely advice on VTE prevention.  The guideline will enable healthcare professionals to protect all patients admitted to hospital.  I welcome this clear advice from NICE and would expect hospitals to implement it. It aims to save lives and reduce risks for patients.”

Professor Tom Treasure, Chair of the NICE Guideline Development Group and professor of Cardio-Thoracic Surgery said: “This NICE guideline is vital in helping to save the 25,000 lives lost each year because of preventable VTE in hospital patients. Put simply, all patients without exception should be assessed on being admitted to hospital for risk of developing a blood clot, and then given preventative treatment that is appropriate for them.  VTE is a silent killer - so it’s the responsibility of medical professionals to take the very simple steps set out in the guideline which can help prevent unnecessary deaths and long term illnesses.”  

Dr Fergus Macbeth, Clinical Director at NICE said: “There is a real clinical need for this guideline. It has been reported that measures to prevent VTE in hospital patients are used inconsistently, and in many cases patients at significant risk of developing a blood clot don’t get any preventative treatment at all. Importantly this guideline covers all patients, not only those having surgery, setting out very clearly what medical staff should now do to assess and address VTE risk.”

The guideline gives recommendations on how to assess if patients are at risk of developing VTE, and importantly their risk of bleeding before blood-thinning drug treatments are used. This includes considering if patients are likely to have reduced mobility for 3 or more days, the type of procedure they are being admitted for, the age of patients and any pre-existing conditions.  Specific recommendations are given for women who are pregnant or have given birth within the previous 6 weeks.

Mr Paul Mainwaring, Patient Representative on the NICE Guideline Development Group and Chair of the Patients’ Council, said: “Developing a DVT can have devastating effects on the individual, as I know from my own personal experience.  I’ve suffered two DVTs which has had an enormous impact not only on my life, but my family too. It created huge pressure on them, living with the knowledge that I could suffer another DVT and not be treated correctly. If all medical staff understand clearly that they must check every single patient admitted to hospital for their risk of developing a clot and then give them the correct treatment, then thousands of patients will avoid what I’ve gone through, or even worse. I’d urge any patient who is admitted to hospital not to be afraid to ask their doctors and nurses about reducing the risk of blood clots - it could help save their life.”

Commenting on the new NICE guideline, Mr John Black, President of the Royal College of Surgeons of England said: “Surgeons from several disciplines were actively involved in producing this guideline because of their concern about the potentially devastating effects of VTE after surgery in their patients. It is a major contribution to safer surgery, which if implemented universally will save lives in the postoperative period, and help to avoid the long-term debilitating problems of the physical damage done to a leg as a consequence of DVT. The Royal College of Surgeons supports the guideline whole-heartedly.”  

Professor Ian Gilmore, President of the Royal College of Physicians, said: “This NICE guideline on VTE will help heighten awareness amongst health professionals of a dangerous but preventable condition.  Patients may not always have symptoms to give a warning - but occasionally VTE can cause pain and swelling in the leg.  The importance of assessing patients on admission, not a day or so afterwards, is raised, along with the need to re-assess patients within 24 hours of admission and whenever the clinical situation changes.  With this guideline, health professionals can now work consistently to help reduce the risk of VTE occurring, and so help reduce the toll of long-term ill health or even death, that has previously occurred.”

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