Please, please read –it’s long, but very important.I t might save some lives.

[HPNC]

I am a regular poster, but have changed my name. If you recognise me please don?t out me. My employers would not be happy that I have posted this.

A couple of weeks ago it was National Thrombosis Week.

Every year, in England, 25,000 ? twenty five thousand ? people die as a result of thrombosis.

That is more than the total deaths from HIV AIDS, breast cancer and road traffic accidents.

It is 25 times the number of deaths from MRSA.

Those 25,000 are the tip of a massive iceberg. They represent a fraction of the total number of people who suffer a thrombosis (blood clot, often called DVT or PE ?Pulmonary Embolism), often as a consequence of being admitted to hospital for medical or surgical treatment.

The single most effective patient safety intervention would be to assess a person?s risk of developing thrombosis when they are admitted to hospital, and to provide that person with the correct, appropriate treatment to prevent thrombosis occurring. (For example, correctly fitted stockings, plus or minus injections to reduce the risk of clotting).

The risk factors are well recognised and risk assessment is a straightforward process.

NICE have already established and implemented guidelines for prevention of thrombosis (thromboprophylaxis) in surgical patients.

NICE are currently drafting the guidelines for risk assessment and preventative treatment for all patients who are admitted to hospital. They will be implemented in 2009.

In April 2007 the Chief Medical Officer, Sir Liam Donaldson, wrote to the Chief Executive of every NHS Trust in England and Ireland stating that every Trust should establish a Thrombosis committee, and set up a system to risk assess every patient who is admitted to hospital, and that this should be mandatory.

By April 2008 only one third of NHS Trusts had taken any action. People are still suffering this horrible condition and still dying.

Please, if you possibly can, write to your local NHS Trust Chief Executive and ask what their Trust is doing to prevent patients dying unnecessarily from blood clots. Copy the letter to your MP.

If you, or a relative, are admitted to hospital for any reason, don?t just ask your doctor or nurse to wash their hands, ask them ?What is my risk of developing a blood clot, and what are you going to do to reduce my risk??

If you are pregnant, please ask your doctor and midwife the same question.

Thrombosis is still a leading cause of pregnancy-related death. If you are pregnant and are admitted to hospital for any reason (apart from straightforward labour and delivery) you should be risk assessed on admission.

We know what the power of mumsnet did for Waitrose baby bottom butter. I really hope we can achieve something here.

Thank you for reading, if you have managed to get this far.

Fishie

If your dad is at home, his diabetes is controlled and he is mobile (as in not in bed all the time)he is probably fine.

But if he were admitted to hospital for any reason, he should be assessed by a qualified person, with regard to his personal risk of developing a clot, whilst in hospital.

That person should then decide what precautions to take.

Your mum fainting on planes is not a question I can really answer, except to say that anyone travelling for hours at a time, whether by plane, train, car or bus, should drink plenty of water, keep wiggling their legs, or walking about if possible.

If they have any risk factors that might increase the chances of thrombosis, then they should get professional advice, as some people could benefit from wearing properly fitted stockings and taking an aspirin before travel. People with a personal or family history of thrombosis might be advised to have injections.

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Thanks for bringing this to our attention HPNC. Really got me wondering now. I was overweight when I had emergency surgery for an ep and I remember being given stockings and told off by Matron? for crossing my legs.

When heavily pregnant with DS I was in and out of hospital for bleeding. I was by then classed as obese , aged 40 and hardly able to move with SPD. There is also a family history of diabetes and both my uncle and grandad died in their 40s of coronary thrombosis. This was a different NHS Trust from the ep. I realise from your previous replies they may not have been able to supply me with stockings but chould anything else have been done?

Elvina

If you were at risk of bleeding, that would have had to have been weighed against the risks of giving you injections to reduce clotting. I cannot tell you what would have been correct in your case.

What is important is that a qualified person - (and in the case of someone who is at risk of developing a clot, but is bleeding, that person should be an expert), should come and take a detailed history and weigh up the pros and cons. They should then decide what is best for YOU.

This should all be written clearly in the medical records, and the situation reviewed frequently, to make sure that the advantages and disadvantages have not changed.

It is all about assessing the individual and making the best decision possible based on the evidence.

To elaborate a bit

Keeping you adequately hydrated and testing frequently for diabetes and treating if necessary would be essential.

Physiotherapy/passive exercise would help if you were not able to move much.

Stockings would be good, but ONLY provided they were the right size and correctly applied.

Injections would not be good if you were bleeding.

The reason for/cause of the bleeding would be important and relevant.

Consideration of the need for intervention/early delivery is also important.

Assessment and constant review is key.

I must go to bed now. Thank you all for reading and posting. I will come back to this when I can. If it makes one person ask about their risk when they go into hospital, it will be worth the effort.

The second lot of guidelines will come in in 2009, but 25,000 more people will have died by then.

i am obese, but have had several surgical procedures for kidney problems. Every time I have had stockings fitted (as most procedures done under spinal, leaving me immobile for several hours). Every time my leg girth was measured and appropriate stockings given. I am on the large side, I think, so for most people they should be available!

airogym

HPNC - do you think this is worthwhile? I use it on all plane journeys ...

Thank you very much for posting this information. I had to fill in a questionnaire last time I was pg about family history of DVT and I forgot that my grandma nearly died of one 20 odd years ago. When DS was born I was in hospital for nearly 2 weeks, mostly on complete bed rest, and no one mentioned DVT as a risk I am pg again and will make sure that I DO mention it this time and if I am ill again I will ask what they are doing to prevent DVT.

It is really crap that hospitals can opt out of these kind of rules.

Sorry - only read OP so hope this is relevant! My Trust has just revamped the drug charts and all charts now have a section that must be filled in to assess risk of DVT. If the patient is assessed as at risk, then prophylactic measures are put in place including prescribing of enoxaparin (a heparin - blood thinning - injection to be given daily at a preventative dose).

Hi RubySlippers

I have had a quick look at this. I certainly think it can't do any harm, especially if you are unable to get up and walk around!

I haven't seen the original research though, so don't know how the trials were designed.

I am not sure if there would be any difference between ordinary foot and leg exercises and the device, but, of course, if the device encourages and reminds you to do the exercises then that can only be good. IYSWIM.

However,if you have a history of multiple DVT, you should get specialist advice to see if you should have heparin injections when flying.

madamy

That's great.

That's what they ALL should be doing, but only 1 in 3 is doing it.

Sorry, that should have been recurrent DVT.

Have not had my second cup of tea yet.

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You can access all the information on the NICE website: look for thromboprophylaxis.

It is also possible to read Sir Liam Donaldson's letter to all NHS Trust Chief Executives.

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SMBK - what were your dd's symptoms? (My son's op on Wednesday, ack!)

Hi JJ. Been thinking of you. dd's clot was post open heart surgery; poor cardiac output, generally in crap condition for want of a better word, and she was on huge amounts of heparin already so it was unavoidable really. The symptoms were a cold, white leg, no pulses whatsoever (clot was in the artery). I'm assuming there would have been pain but she was on the vent.

I do think it's something that you should make sure is covered next week, especially as ds will be pretty immobile for a while. They were very careful about dd following her ortho surgery due to her history (she takes aspirin daily anyway) but I did have a bit of a scare with her when she woke up the first night at home post op with chest pain. Thankfully it passed off and was more of a muscle spasm. But the most important thing I think was that I was aware of what could happen and was ready to take appropriate action.

Sorry to add to your worries BTW but better to be enlightened and on the lookout I think.

there is no evidence that stockings prevent leg DVTs, BTW.

DH said that the obese are most at risk, as are smokers.

I will put this in my book (literally, I keep a notebook because I am old and forgetful) - thanks. My husband just had foot surgery two weeks ago and had one of the stockings fitted. I know the company health people have also given him special ones to wear on flights, too, as he travels a lot.

Hope your dd is doing well! And thanks again for all the support.

Thanks for this HPNC.

The Health Technology Assessment 2005 showed that mechanical interventions, including graduated compression stockings, reduced the incidence of proximal vein thrombosis by 50% and pulmonary embolism by 2 fifths.

Mr John Scurr carried out a study on the benefits of elastic compression stockings in 2001 which showed that there was a demonstrable benefit.

I agree there is a need for further study, but the NICE committee did a huge amount of extremely careful, detailed research, going back to all the original papers before formulating the current guidelines.

They do stress that stockings must be of the correct compression, properly fitted and applied.

Most importantly, it is individual risk assessment that is recommended.

HTA REPORT - sorry - typing too fast.

There are other studies, but I haven't got all my references here ATM.

But, there is evidence that stockings are useful, as part of a package of measures, based on individual risk.