Politic developments in thrombosis prevention

1
Political developments in VTE
2
Government documents on VTE prevention
March 2005 July 2005 April 2007
April 2007
3
Government documents on VTE prevention

• House of Commons Health Committee Meeting
• Dec 2004
• House of Common Health Committee Report
• March 2005
• Government response to Health Committee Report
• July 2005
• Independent expert working group report
• April 2007
• NICE guidelines on high risk surgery
• April 2007

4
Health Committee Enquiry into VTE
5
Health Committee Written evidence
6
Health Committee Witnesses
7
Health Committee Report

• Each year gt25000 people in England die from
  thrombosis contracted in hospital
• The total is more than the combined total of
  deaths from breast cancer, AIDS and traffic
  accidents
• The total is gt25 times the number of patients who
  are estimated to die from MRSA

8
Health Committee Report

• Key recommendations
• Raise awareness of VTE
• Provide a VTE national guideline
• Improve VTE education
• The implementation of practice recommendations
  are required at a local level
• Recommendations for risk assessment and the
  creation of Thrombosis Committees and Thrombosis
  Teams in hospitals

9
Government response to Health Committee

• The CMO wrote to all doctors pointing out the
  existing guidelines
• The CMO instigated the formation of an
  independent expert working group
• Discussions with NICE initiated regarding a
  clinical guideline for acutely ill medical
  patients
• All bodies involved in medical education
  contacted and asked to update their curricula to
  reflect problem of VTE

10
Remit of expert working group

• To review current guidelines and the evidence
  base on prevention of VTE
• To clarify the role of aspirin
• To consider the best approach to improving VTE
  awareness and education
• To consider monitoring systems to improve data on
  outcome after VTE including mortality
• To make formal recommendations on implementation
  of thrombosis prevention

11
Report of expert working group published April 07
12
NICE Clinical Guideline 46 remit
To develop safety guidance for the NHS in England
and Wales on prophylaxis against venous
thromboembolism (VTE) for patients undergoing
orthopaedic surgery and other surgical procedures
for which there is a high risk of VTE. The
guidance should set out the principles of
clinical and cost effective practice and in
particular should address
13
NICE Clinical Guideline 46 remit
(i) the assessment of risk for particular
procedures and for individual patients (ii) the
circumstances in which prophylaxis can be
recommended as clinically and cost
effective (iii) the appropriate selection of
interventions including both pharmaceutical and
mechanical methods of prophylaxis
14
What NICE Clinical Guideline 46 covers

• Adults (age 18 and older) undergoing
  inpatient surgery that carries a high risk of
  VTE, including
• orthopaedic surgery (for example, total hip/knee
  replacement/hip fracture)
• major general surgery
• major gynaecological surgery (not including
  elective/emergency caesarean)
• urological surgery (including major or open
  urological procedures)
• neurosurgery
• cardiothoracic surgery
• major peripheral vascular surgery
• There may be other surgical procedures requiring
  an inpatient stay and
• healthcare professionals should exercise their
  clinical judgement when
• making decisions on the appropriateness of VTE
  prophylaxis.

15
NICE guideline published April 07

• This guideline assesses the evidence for the
  effectiveness of risk reduction measures
• It provides recommendations on the most
  clinically and cost-effective measures to reduce
  the risk of VTE in inpatients having surgery