Consensus Statements and Guidelines on Antithrombotic Therapy

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Consensus Statements and Guidelines on
Antithrombotic Therapy

• VTE is a major health problem, particularly among
  the elderly.
• Symptoms non-specific, first clinical
  presentation is often fatal PE.
• Undetected DVT post-thrombotic syndrome and
  recurrent DVT.
• The Sixth ACCP consensus statement and guidelines
  prevention and management of VTE.
  evidence-based review

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• Despite the availability of these guidelines,
  thromboprophylaxis tends to be underutilized,
  especially in the medical setting.

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• The magnitude of the problem.
• Risk factors for VTE.
• Underutilization of thromboprophylaxis

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• Public Figures Affected by PE
• The former Vice-president of the USA, Dan Quayle,
  was diagnosed with an infection of the upper
  respiratory tract. After failing to respond to
  treatment, he was found to be suffering from
  multiple pulmonary emboli.

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• VTE is one of the leading causes of death in the
  USA
• killing more people than AIDS, breast cancer,
  and road-traffic accidents combined.
• Coronary heart disease 400,000
• PE,200,000
• Accidents 97,900
• Highway fetalities 42,815
• Breast cancer 40,200
• AIDS 14,478

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DVT 200,000
Post thrombotic syndrome 800,000
PE 600,000
PHT 30,000
Death 60,000
Lancet 19993531386-9
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Major PE diagnosed at Autopsy
Patient group PE suspensions prior to death No PE suspensions prior to death
Post op patient (n11) 7(64) 6 (36)
Medically ill patients (n50) 13(26) 37(74)
Total (n61) 20(33) 41( 67 )
Framingham study 3,470 patients, autopsy in 39
of 998 patients.1 Overall, 16 of these patients
were found to have suffered a fatal PE.
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Fatal PE Diagnosed at Autopsy in Medical Patients

Nielsen et al1983 Scandinavia 83
Hauch et al1990 Denmark 78
Sperry et al1990 USA 59
Cohen et al1996 UK 81

Framingham study, with approximately
three-quarters of fatal pulmonary emboli in
medical patients being diagnosed at autopsy