Combating DVT and PE: Critical recommendations

Three critical recommendations from a national workshop have been released to address deep-vein thrombosis (DVT) and pulmonary embolism (PE), a growing public health problem estimated to affect nearly 1 million Americans each year. The recommendations - developed by a diverse group of representatives from federal health agencies and patient groups, as well as experts from the medical and public health communities - appear in the March 9, 2010, Supplement to American Journal of Preventive Medicine (AJPM): Blood Disorders in Public Health - Making the Connection. AJPM is a publication of the American College of Preventive Medicine (ACPM) and Association for Prevention Teaching and Research (APTR). The special supplement is being released in conjunction with the first annual National Conference on Blood Disorders in Public Health on March 9-11, 2010, in Atlanta, GA.

Normal blood clotting is important for preventing excessive bleeding due to injury; however, in DVT a clot forms inside a deep vein, usually in the lower limbs. If left untreated, the clot can break loose and travel to the lungs, a life-threatening condition called PE. An estimated 300,000 people die from PE in the United States each year.

"DVT is of such concern that the U.S. Surgeon General issued a call to action last fall to help raise public awareness about the disorder and increase research on the causes, prevention, and treatment for DVT and PE," said Gary Raskob, PhD, lead author of the AJPM paper and Dean of the College of Public Health at the University of Oklahoma Health Sciences Center. "Though it's a common disorder, DVT is highly preventable. That's why spreading the word about who's at risk and the steps one can take to prevent these dangerous clots is so important."

The recommendations, developed by a group of experts convened by the American Society of Hematology (ASH), are:

• There is a need to strengthen surveillance of DVT and PE in the United States to provide a geographically representative measure of the annual incidences of DVT and PE, with appropriate representation of all minority groups in proportions approximating the U.S. population.
• The Centers for Disease Control and Prevention (CDC) should establish a group of experts to advise on the scientific approaches for strengthened surveillance of DVT and PE, including the appropriate use of prospective population-based studies, and the role for national or regional databases.
• Increased public awareness of the risk factors for DVT and PE is critical to increasing the application of preventive measures. The CDC should undertake, in cooperation with relevant partners, a national campaign to increase public awareness of DVT and PE.

"Currently, there isn't a national system for monitoring changes in the incidence of DVT and PE," said Hani K. Atrash, MD, MPH, Director of the CDC's Division of Blood Disorders. "It's time to put in place an ongoing method of documenting the prevalence of these disorders and their consequences, identifying individuals affected by them, and determining which medical and public health strategies are working - or not working - to prevent and reduce DVT and PE."

The recommendations for this national strategy to further research and combat DVT and PE - collectively known as venous thromboembolism (VTE) - come at a time when concrete evidence has shown that the risk of VTE is three times higher for air travelers, according to a recent study published in the Annals of Internal Medicine. Being immobile for long periods, such as in an airplane or during a long hospital stay, increases the risk of clotting due to the restriction of blood flow. To reduce the risk, travelers are advised to stay active on the plane and stay hydrated by drinking lots of water and avoiding alcoholic beverages.

In the arms or legs, DVT can cause sudden pain, swelling, and tenderness; PE symptoms include chest pain, shortness of breath, and sweating. Risk factors include surgery or trauma, hospitalization for a medical illness, cancer, obesity, smoking, pregnancy, oral contraceptive use, age over 60, a family history of these blood clots, and others. More information on these clotting disorders can be obtained from ASH's patient-oriented Web site, www.BloodTheVitalConnection.org.