Venous thromboembolism (VTE) is a disease process that includes deep vein thrombosis (DVT) and pulmonary embolism (PE). In DVT, a blood clot (thrombus) forms in the deep veins, most commonly in the legs or pelvis, where it may cause pain, tenderness or swelling in the leg. In PE, some or all of the clot becomes detached and moves from the vein through the right side of the heart to lodge in one or more of the arteries in the lung (pulmonary arteries). Symptoms of PE include difficulty breathing, coughing up of blood, chest pain, faintness, loss of consciousness, heart failure and cardiac arrest. If the clot fully blocks the lung arteries, it may cause death.1
VTE is a major cause of morbidity and mortality for patients admitted to hospital, and a common preventable cause of in-hospital death. It is estimated to account for 7% of all deaths in Australian hospitals, and the consequence of developing VTE has been estimated to cost the Australian health system $1.72 billion annually.2
Despite current efforts, evidence suggests that a large proportion of hospitalised patients are at risk of VTE, however many patients do not receive appropriate VTE prophylaxis.3,4 VTE prevention strategies have been shown to significantly reduce the incidence of VTE by about 70%.
While the incidence of VTE among hospitalised patients is 100 times greater than in the community5, the risk of developing VTE also continues after discharge from hospital. Hospitalisation is a major risk factor for VTE, with about 74% of VTE cases occurring up to three months after hospital discharge.6
The key clinical guideline in Australia for VTE prevention in hospitalised patients was rescinded in 2016.1 The development of a VTE Prevention Clinical Care Standard was proposed by states and territory health departments as a way of improving the uptake of appropriate VTE prophylaxis strategies.
1. National Health and Medical Research Council. Clinical practice guidelines for the prevention of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to Australian hospitals (rescinded 2016). Melbourne: NHMRC; 2009.
2. Access Economics Pty Ltd for the Australia and New Zealand working party on the management and prevention of venous thromboembolism. The burden of venous thromboembolism in Australia, 1 May 2008. Access Economics Pty Ltd; 2008.
3. Assareh H, Chen J, Ou L, Hillman K, Flabouris A. Incidences and variations of hospital acquired venous thromboembolism in Australian hospitals: a population-based study. BMC Health Services Research. 2016;16:511.
4. Cohen A, Tapson V, Bergmann J-F, Goldhaber S et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. The Lancet. 2008; 371:387-394.
5. Heit JA, Melton LJ, III, Lohse CM, Petterson TM, Silverstein MD, Mohr DN, et al. Incidence of venous thromboembolism in hospitalized patients vs community residents. Mayo Clinic Proceedings. 2001.76(11):1102-10.
6. Spencer FA, Lessard D, Emery C, Reed G, Goldberg RJ. Venous thromboembolism in the outpatient setting. Archives of Internal Medicine. 2007;167(14):1471-5.