CALL TO ACTION TO PREVENT VENOUS THROMBOEMBOLISM- ABSTRACT

Wakefield TW, McLafferty RB, Lohr JM, Caprini JA, Gillespie DL, Passman MA; Executive Committee of the American Venous Forum.

Section of Vascular Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA. thomasww@umich.edu

Deep venous thrombosis and pulmonary embolism, together called venous thromboembolism, remain a serious national health problem. Estimates suggest that over 900,000 cases occur in the United States per year, with 300,000 deaths per year. Because of the significant and serious nature of this problem, a workshop was held in May of 2006, which resulted in the Acting U.S. Public Health Service Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. On September 15, 2008, Acting Surgeon General, Rear Admiral Steven K. Galson, MD, MPH, and Elizabeth Nabel, MD, Director National Heart, Lung, and Blood Institute, announced the Call to Action. The Call to Action highlights public awareness about the risk factors, triggering events, and symptoms of venous thrombosis and pulmonary embolism, and encourages the development of evidence based practices for screening, prevention, diagnosis, and treatment of venous thrombosis and pulmonary embolism. It is designed to encourage new scientific investigation in an effort to obtain needed evidence to fill in the gaps of knowledge about venous thrombosis and pulmonary embolism. This knowledge should be quickly and easily disseminated to the public and put into practice by health professionals. The Surgeon General's Call to Action represents one of the most important advances in the field of venous thromboembolism and sets the stage for multidisciplinary efforts to combat this serious national health problem.

November to be Deep Vein Thrombosis (DVT) Awareness Month in Massachusetts

On September 26, a dedication ceremony held at Brigham and Women's Hospital in Boston commemorated the filing of a bill that will permanently declare November Thrombosis Awareness Month in Massachusetts.

State Representative Angelo J. Puppolo, Jr. of the Twelfth Hampden District filed the bill, working closely with Samuel Z. Goldhaber, MD, President of the North American Thrombosis Forum (NATF), as well as several other healthcare professionals in his district and at Brigham and Women's and Massachusetts General Hospitals in Boston.

The full text of the official Thrombosis Proclamation notes that "positive lifestyle choices and/or treatment during high-risk situations could prevent blood clots in a significant number" of the almost 300,000 people who die of thrombosis-related disease annually in the United States.

"This is a great beginning of raising awareness of this disease in the Commonwealth," stated Puppolo at the September ceremony.

NATF is grateful to Representative Puppolo for his efforts in increasing thrombosis awareness and looks forward to continuing to work with him on thrombosis-related projects.

South Asian Society on Atherosclerosis & Thrombosis Proposes Regulatory Guidelines for Generic Low Molecular Weight Heparins

The 1st International Summit of SASAT for Generic Low Molecular Weight Heparins (LMWHs) was held in N. Delhi, in October 2007.  In this summit a strong recommendation to develop newer guidelines for the development of generic versions of LMWHs were proposed. As of 2008, several generic LMWHs have become available and widely prescribed in 17 countries.  Wide compositional variations have been noted among the generic LMWHs.  Some substandard products were also withdrawn due to compositional variations and non-adherence to specifications.  The primary objectives of this meeting were to review the current recommendations from major organizations and regulatory bodies, and to provide standards & guidelines for the safe approval of generic LMWHs."

Click here to see full Proposal

From Thrombosis Clinic(TM):

Dr. Samuel Z. Goldhaber discusses the United States Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism
Recently, the US Surgeon General issued an historic "Call to Action" aimed at reducing the rate of venous thromboembolism in hospitalized patients. In this informative video, Samuel Goldhaber, MD, who served as an advisor to the Surgeon General, discusses the thinking behind the Call to Action and its implications for patient care.

ATLAS ACS-TIMI 46 and TIMACS Late-breaking Clinical Trials
At the American Heart Association 2008 Scientific Sessions held in New Orleans, LA, in November, several clinical trials were presented that have the potential to affect clinical practice for the treatment of acute coronary syndrome (ACS). In this lively ThrombosisClinic.com video forum, Drs Deepak Bhatt and Robert Giugliano discuss 2 of the late-breaking clinical trials, ATLAS ACS-TIMI 46 and TIMACS, and the potential impact that they may have on current and future treatment of ACS.

Medicare and Medicaid Move Aggressively to Encourage Greater Patient Safety in Hospital and Reduce Never Events

The Centers for Medicare & Medicaid Services (CMS) announced that it is taking several actions to improve the quality of care in hospitals and reduce the number of “never events” -- preventable medical errors that result in serious consequences for the patient. Hospital acquired deep vein thrombosis and pulmonary embolism is amongst these “Never Events”. Hospitals will no longer be reimbursed for medical costs that occur as a result of deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures.

More information can be found on the July 31, 2008 CMS press release.

National Quality Forum endorses standards designed to reduce VTE during hospitalization

Each year, in the United States alone, somewhere between 900,000 to 2,000,000 people will develop blood clots (venous thromboembolism or VTE) in the lungs or major veins.  Annually, more people die from blood clots and the resulting complications than from AIDS, breast cancer, and motor vehicle accidents combined.  Fatal pulmonary embolism (PE) – blood clot in the lungs – may be the most common preventable cause of hospital death in the United States. 
 
In May 2008, the National Quality Forum (NQF) endorsed 6 proposed standards designed to improve the performance of acute care hospitals.  Included in the measures are prevention and care of VTE.  The specified measures are:

• VTE Prophylaxis
  
• VTE Prophylaxis in the ICU
  
• Patients with overlap in anticoagulation therapy
  
• Patients with UFH (Unfractionated Heparin) dosages who have platelet count monitoring and adjustment of medication per protocol or nomogram
  
• Discharge instruction to address: follow-up monitoring compliance, dietary restrictions, and adverse drug reactions/interactions
  
• Incidence of preventable VTE
  

CMS Expands Coverage for INR Home Monitoring

Courtesy of Tom Hogan, Secretary - National Alliance for Thrombosis and Thrombophilia (NATT)

The Center for Medicare and Medicaid Services (CMS) is expanding its coverage of INR home monitoring to include patients on warfarin for DVT (deep vein thrombosis) and PE (pulmonary embolism), i.e., VTE (venous thromboembolism, blood clots in the legs and arms). Previously, CMS provided coverage only for home INR testing of patients with mechanical heart valves.
 
The CMS Decision Summary is as follows:

"After examining additional medical evidence, we are expanding Medicare coverage of home prothrombin (INR) monitoring to include chronic atrial fibrillation and venous thromboembolism under the following conditions:

• The beneficiary requires chronic oral anticoagulation with warfarin for a mechanical heart valve, chronic atrial fibrillation, or venous thromboembolism; and
  
• The beneficiary has been anticoagulated for at least three months prior to use of the home INR device; and
  
• The beneficiary has undergone a face-to-face educational program on anticoagulation management and demonstrated the correct use of the device prior to its use in the home, and
  
• Home-testing with the device occurs no more frequently than once a week."
  

Rear Admiral Steven K. Galson, MD, MPH was appointed Acting Surgeon General on October 1, 2007.

Meanwhile, on September 13, 2007, a treasure chest of information from the May 8-9, 2006 Surgeon General’s DVT Workshop was finally opened!  The 22 sets of slides and 22 manuscripts from the two-day workshop were posted on the Surgeon General’s website under “DVT Proceedings” at: www.surgeongeneral.gov/topics/deepvein/workshop/agenda.htm

If this link doesn’t work, try the following 5 steps:

1. access www.surgeongeneral.gov
2. click on “Reports and Publications”
3. click on “Workshop Reports and Proceedings”
4. click on “DVT Workshop Proceedings”
5. click on “Agenda”

Each set of slides is formatted in both PowerPoint (so that the slides can be easily copied) and in pdf files.  Each manuscript that accompanies a slide set is well referenced and often contains supplemental tables and figures.

Under joint sponsorship of the NHLBI and Office of the Surgeon General, the Surgeon General’s DVT workshop took place on May 8-9, 2006 in Bethesda, MD.  Thomas Ortel, MD, PhD and I were the science co-chairs for this meeting.  We organized seven panels:  epidemiology, high risk groups, diagnosis, treatment, awareness and best practices, prevention, and finally, translation and application.  WE also assembled five workshops:  enhancing diagnosis and treatment, primary prevention, DVT science base and accelerating public health, public health priorities, and enhancing collaborations and developing new partnerships.

At the conclusion of the 2-day workshop, Richard Carmona, MD, the Surgeon General, issued a “Call To Action.”  However, his appointment as Surgeon General expired in August 2006, and he was not renominated.  James W. Holsinger, Jr., MD, a Kentucky cardiologist, has been nominated for Surgeon general.  He underwent a blithering Senate confirmation hearing on July 12, 2007.  The vote on his nomination was supposed to be held on September 2007 but has obviously been delayed.