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•

References:
http://www.qualityforum.org/projects/ongoing/vte/index.asp

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."

References:
http://www.nattinfo.org/Newsletters/NATT_Winter_07_Newsletter_Final.pdf
http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=209

MAINE DECLARES: "NOVEMBER 2008 THROMBOSIS AWARENESS MONTH"

WHEREAS, The National Alliance for Thrombosis and Thrombophilia reports that more than an estimated 900,000 people in the United States will develop thromboembolism or clots of the veins every year, 380,000 of which will develop deep vein thrombosis which occurs in the inner vein of the leg; and

WHEREAS, pulmonary embolism, a serious and often fatal complication of deep vein thrombosis, affects 530,000 people in the United States annually; and

WHEREAS, almost 300,000 people die each year in the United States due to blood clots in the veins; and

WHEREAS, hereditary thrombophilia, an inherited predisposition to blood clots affects approximately 1 in 20 people in the United States; and

WHEREAS, positive life style choices and/or treatment during high risk situations could prevent blood clots in many of the affected individuals; and

WHEREAS, through public awareness, the State of Maine seeks to minimize the effects of thrombosis among its citizens,

NOW, THEREFORE, I, JOHN E. BALDACCI, Governor of the State of Maine, do hereby proclaim the month of November, 2008 as

THROMBOSIS AWARENESS MONTH

throughout the State of Maine, and urge all citizens to recognize this observance.

Click here to view the official proclamation signed by Governor John E. Baldacci

 

MASSACHUSETTS DECLARES: "NOVEMBER IS THROMBOSIS AWARENESS MONTH"

November 15, 2007/3:25 p.m. (EST): Governor Deval Patrick of Massachusetts declared November as “Thrombosis Awareness month in the Commonwealth of Massachusetts."  On November 15, 2007, he presented the formal “Office of the Governor” proclamation in a special ceremony at the State House.

“Through public awareness, the Commonwealth of Massachusetts seeks to minimize the effects of thrombosis among all Massachusetts citizens…and urges all the citizens of the Commonwealth to take cognizance of this event and participate fittingly in its observance,” the proclamation states in part. 

At the same ceremony, held in the State House’s historic “Nurses Hall,” State Representatives Angelo J. Puppolo, Jr. and Michael F. Rush presented Resolutions adopted by the House of Representatives, recognizing November 2007 as “Thrombosis Month” in Massachusetts.

The House of Representatives Resolution was signed by the Speaker of the House, Salvatore F. DiMasi, and states in part:  “Pulmonary embolism is a serious and often fatal complication of deep vein thrombosis, and affects about 530,000 people in the United States annually.” 

Samuel Z. Goldhaber, MD, President of the North American Thrombosis Forum and Director of the Venous Thromboembolism Research Group at Brigham and Women’s Hospital, gave opening remarks at the State House ceremony.  He described different types of thrombosis that cause illness, including myocardial infarction, stroke, pulmonary embolism, deep vein thrombosis, and peripheral vascular disease.  He added that thrombotic conditions constitute the most frequent illness in North America and that this is a local, state, regional, national, and now global health threat.    By educating the lay public and health care professionals about thrombosis, more preventive strategies will be practiced, and those afflicted by thrombotic conditions will seek earlier and more effective treatment. 

Goldhaber said that volunteerism is an important part of the equation.  He pointed to groups such as the nonprofit North American Thrombosis Forum (www.NATFonline.org) as well as the Venous Disease Coalition (www.venousdiseasecoalition.org) as examples multidisciplinary teamwork that is increasing educational efforts about thrombotic disease.  He also noted the importance of scientists, clinicians, government officials, patients, and industry to partner.  The Commonwealth of Massachusetts excels in these multidisciplinary activities. 

Lynn Oertel, RN, from Massachusetts General Hospital then spoke about the “Role of the Nurse” in advancing Thrombosis Awareness.  And John Fanikos, RPh, MBA, Assistant Director of the Pharmacy at Brigham and Women’s Hospital, discussed the “Role of the Pharmacist.”  Arthur Sasahara, MD, Senior Member of the BWH Venous Thromboembolism Research Group, concluded with a historical perspective on the value of increasing Thrombosis Awareness and expressed his appreciation for the support of the Massachusetts Executive and Legislative branches of government.

NATF Directors and Advisory Committee Members are available for comment and questions regarding DVT and other thrombotic events. Please contact Ilene Sussman at isussman@natfonline.org or 617-525-8326 for more information.

"The Surgeon General's DVT Workshop and Call-To-Action"

Samuel Z. Goldhaber, MD
Professor of Medicine, Harvard Medical School

Click here to view the Adobe Presenter version of Dr. Goldhaber's Thrombosis Summit 2007 lecture.

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. 

Releasing the Proceedings of the DVT Workshop is a great start.  But it is not nearly as important as issuing a “Call-To-Action.”  The Workshop organizers have edited a 40-page text which is ready for publication in conjunction with the Surgeon General’s “Call-To-Action.”  However, this anticipated landmark event may have to await the naming of the 18th Surgeon General of the USA.

Making a Difference: Kelly’s Story

Kelly Clark is a 40-year-old professional and mother of two young children, who resides in Aliso Viejo, California. In early 2007, Kelly was diagnosed with a pulmonary embolism following arthroscopic knee surgery. Thrombosis awareness, education, and prevention have now become her passion. We are pleased to welcome Kelly as a NATF Patient Advocate.

Click here to view Kelly's Story: Deep Vein Thrombosis and Pulmonary Embolism

Making a Difference: Nicole's Story - APRIL 2008 UPDATE!

April 15, 2008; 6:40 p.m. (EST): It was a year ago this month that I was diagnosed with a cerebral venous thrombosis. So after my USC Neurologist ran every genetic test possible this month, and everything showed up completely normal, I felt such a huge relief since I had a new daughter. My Neurologist said that most likely my cerebral venous thrombosis (CVT) was due to the infection of Sinusitis with Mastoiditis that my MRI had shown with my thrombosis. My clot is permanent and will never diminish in size, however, my doctors believe it was a one-time occurrence, and God-willing will not get any bigger. In October 2007, the anti-seizure medication (Keppra) that I was taking, caused me to have no appetite. Being on Warfarin blood-thinners still, my blood became extremely thin. I had to immediately discontinue Warfarin and was slowly weaned off the Keppra. My Neurologist advised me that since my thrombosis was most likely a one-time occurrence I would only have be on life-long permanent Aspirin therapy (325mg) daily. Otherwise I could live a completely normal life, no more weekly blood draws to check Warfarin levels, since Aspirin therapy does not register on blood draws. I was told by my Neurologist and OB/GYN that having more children one day was absolutely possible and I would only need to continue my Aspirin therapy during my pregnancy. I wouldn’t even need the Heparin therapy normally used in women with thrombosis, since mine wasn’t due to a predisposition for blood-clotting. After everything, the birth of my daughter, and my thrombosis experience starting only weeks later; I could never put into words how blessed I feel that it was not genetic, for my daughter’s sake, that I can return to normal living with out a worry of predisposition, and that as horrible an experience as it was I am truly all the better of a person for it. I look at everyday of my life with my daughter as a miracle, because a year ago April 18th, they told me I wouldn’t see her first birthday. It has taught me how absolutely precious life is and I cherish every moment I have.

During my hospital stay in April 2007 due to thrombosis, my daughter's biological father, (Eric Gomer) mentioned in my original story, couldn’t handle having the responsibility of a new daughter and a sick girlfriend and chose to leave our lives. He since has had no part in my or my daughter’s life. But I was again blessed with a miracle; a friend, Jeremy De Jong, that I have known for 4 years, due to our parents being good friends, became my biggest support, best friend, father to my daughter, and now future husband. We are planning our wedding for this September.

Click here to view Nicole's Story: Cerebral Venous Thromboembolism

Patient Advocacy: Melanie Bloom and The Coalition to Prevent DVT

Click here to view Melanie's lecture from Thrombosis Summit 2007 – September 29, 2007

Melanie Bloom’s husband, David, was an NBC correspondent embedded with the 3rd Infantry Division in Iraq when he suddenly collapsed and died from massive pulmonary embolism (PE).  That tragedy was Melanie’s rude awakening to the realities of PE and deep vein thrombosis (DVT), a condition that affects approximately 2,000,000 Americans every year.  She, like most Americans, had never heard of the “silent killer” that took her husband’s life.

Inspired by the enormous outpouring of support for her personal loss, Melanie pledged to increase awareness of PE and DVT by working with the Coalition to Prevent DVT, a group of organizations committed to educating the public and healthcare community about DVT.  The Coalition’s mission is:

To reduce the immediate and long-term dangers of DVT and PE, which together comprise one of the nation’s leading causes of death.  The Coalition will educate the public, healthcare professionals, and policy-makers about risk factors, symptoms, and signs associated with DVT, as well as identify evidence-based measures to prevent morbidity and mortality from DVT and PE.

The Coalition’s website is: www.preventdvt.org.

As the Coalition’s patient advocate, Melanie educates audiences of healthcare professionals, consumers, and members of the media to be alert to the risk factors and symptoms of DVT, which can strike even healthy adults seemingly at random.  Common risk factors include restricted mobility, major surgery, cancer, and certain heart or respiratory diseases.  Symptoms of DVT include pain, swelling, tenderness, discoloration, or redness of the affected area, and skin that is warm to the touch.

To date, the Coalition’s message has reached millions of people across the country.  Melanie has appeared on the Today Show, Access Hollywood, CNN’s American Morning, the Jane Pauley Show, and Larry King Live.  She shared her story in the Coalition to Prevent DVT’s public service announcement that continues to air nationally, and she has been featured in both Ladies Home Journal and the 2005 Oscar issue of People magazine.  In March 2005, Melanie and the Coalition drew members of Congress, staffers, and members of the media to a Capitol Hill celebration of a Senate Resolution officially declaring March as DVT Awareness Month.  Melanie represented the Coalition at major medical meetings for the American College of Chest Physicians (ACCP) and Vascular InterVentional Advances (VIVA), spoke at a DVT lecture series at Jefferson Medical College in Philadelphia, and participated in a film shoot and Web cast for internal distribution at the Hospital Corporation of America (HCA).  At every event, Melanie recounts her loss to emphasize the importance of increased awareness of DVT and to encourage the widespread implementation of prophylaxis measures.

Throughout 2006, Melanie will continue working with the Coalition, telling her story and encouraging other patients to share their experiences with DVT.  Together with the Coalition, she will help reach policy leaders and a wider audience of healthcare professionals. 

Melanie welcomes the opportunity to speak at Brigham and Women’s Hospital and Harvard Medical School and to share her story, as she seeks to raise awareness of DVT.  She is especially pleased to be the inaugural speaker of this new Continuing Education course directed by Arthur A. Sasahara, MD:  “Proactive Venous Thromboembolism Prophylaxis:  Multidisciplinary Prevention of Pulmonary Embolism and Deep Vein Thrombosis.”