APPENDIX 3
Memorandum by Huntleigh Healthcare (VT
5)
Huntleigh Technology PLC is a leading medical,
engineering, manufacturing and service group providing patient
solutions within the healthcare market.
Huntleigh Healthcare's association with Deep
Vein Thrombosis (DVT) prevention originates from the 1970's when
we worked closely with a London teaching hospital to develop the
foundation for our prophylaxis systems.
INCIDENCE/PREVALENCE
OF DVT AND
PULMONARY EMBOLISM
(PE)
DVT (clinically recognised) and/or PE occurs
in 2:1,000 persons each year in the general population1. In the
hospitalised population DVT and PE are much more common due to
a combination of acute injury/surgery and immobilisation.
The Scottish Intercollegiate Guidelines Network
(SIGN) issued National Clinical Guidelines on prophylaxis of venous
thromboembolism in 1995 (due to be updated June 2000). They reported
the results of screening studies of hospitalised patients that
showed DVT incidence in moderate risk patients of 10-40% and of
40-80% in high-risk patients. The risk of fatal PE in the high-risk
group was between 1 and 10%.
DVT and PE incidence in hip and knee replacements
is estimated at around 4%, major trauma has a fatal PE rate of
about 1% and a venographic DVT prevalence of 58%. Urological surgery
has DVT rates of 40-80% for calf vein and 10-20% for thigh vein
and 1-5% for fatal PE. Pulmonary embolism is the commonest cause
of maternal death during pregnancy and the puerperium2.
DVT prevalence from post-mortem studies of a
cross-section of patients range from 54-62%, in part due to differences
in the dissection techniques used3. The incidence of symptomatic
and asymptomatic PE was found to be 6.5% and 11.5% respectively
in a group of post-operative patients4. A retrospective analysis
of autopsy reports found PE as a cause of death in 10% in general
hospital patients, 83% of these patients had DVT in the legs at
autopsy5.
The THRiFT repost highlights the need to consider
long-term cost effectiveness, and cites the direct cost to primary
care and society such as death, recurrent DVT, chronic insufficiency
and post-phlebitic syndrome as important factors6.
Several studies have investigated the relationship
between the acute DVT, long-term venous haemodynamic disturbances
and the incidence of post-thrombotic syndrome. The incidence of
post-thrombotic syndrome has been reported to be 35-69% at 3 years
after DVT and 49-100% at 5-10 years7.
Venous ulcers develop in at least 300 per 100,000
population and the proportion due to DVT is approximately 25%.
The annual cost of treating venous ulcers has been estimated to
be 400 million pounds for the UK7.
Appropriate prophylaxis is believed to be able
to halve the incidence of DVT (Ref No 5 in the Stephen McAndrew
article); 0.9% of hospitalised patients die of a PE (approximately
10 times as many as die of Hospital Acquired Infections).
Highly effective prophylactic measures exist.
Selection is dependent on a patients risk level, contraindications
related to an individual's clinical condition and physician choice;
in high and very high risk patients prophylactic methods are generally
combined to provide additional protection.
Methods of prophylaxis are early mobilisation,
graduated compression stockings, pharmalogical agents such as
low molecular weight, Heparin and Intermittent Pneumatic Compression.
The consequences of DVT and PE are such that
they can be regarded as public health issues. National policy
making needs to address two fundamental issues; firstly the lack
of agreed and universally applied protocols of care, even though
national, European and international consensus statements exist,
and secondly, a joined up approach to funding where the provision
of prophylaxis crosses the responsibility of more than one hospital
department (for example operating theatres and wards) and from
hospital into the community, where extended prophylaxis is required.
Business Director
REFERENCE LIST1.
The Scottish Intercollegiate Guidelines Network (SIGN)(1995).
National Clinical Guidelines on prophylaxis of venous thromboembolism.
University of Dundee.
2. Turnbull, A Tindall, V, Beard, R et al (1989).
Confidential enquiry into maternal deaths in England and Wales
1982-84, London HMSO pp: 28-36.
3. Griffin, J (1996). Deep Vein Thrombosis and
Pulmonary Embolism. Office of Health Economics, London.
4. Rodzynek JJ et al (1985). Incidence of asymptomatic
pulmonary embolism after surgery. Thrombosis and Haemostasis,
54:39.
5. Sandler DA and Martin JF (1989). Autopsy
proven pulmonary embolism in hospital patients: Are we detecting
enough deep vein thrombosis? Journal of the Royal Society of Medicine,
82:203-205.
6. THRiFT II (1998). Risk of and prophylaxis
for venous thromboembolismin Hospital Patients. Phlebology13:
87-97.
7. International Consensus Statement. Prevention
of Venous Thromboembolism, London: Med-Orion Publishing, 1997.
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