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Armstrong Institute for Patient Safety and Quality

 
Preventing Venous Thromboembolism Doctor and nurse speaking to patient in a bed
 

Deep vein thrombosis (DVT)—the formation of a blood clot in a deep vein—and pulmonary embolism (PE)—a blood clot that travels to the lungs—together comprise the most common preventable cause of hospital-related death. Known together as venous thromboembolism (VTE), they claim more than 100,000 lives a year in the United States.

There is strong evidence that anti-clotting medications and mechanical prophylaxis, such as compression devices, can prevent a majority of blood clots in the hospital. Yet blood clot prevention is truly complicated. Prescribers must tailor prophylaxis to the individual patient, by considering risk factors and contraindications. Studies have found that appropriate prophylaxis is ordered for only 32 percent to 59 percent of patients. Additionally, an emerging body of research shows that once prophylaxis is ordered, treatments often do not reach patients.

 

2019 Minogue Award for Patient Safety Innovation

Johns Hopkins VTE Collaborative was awarded the Circle of Honor award for their submission, "Utilizing Information Technology to Prevent Venous Thromboembolism."

Learn about the award

 

PE graphicClick on the image to view the full size version.

 

Why Focus on VTE Prevention?

  • VTE is common. There are an estimated 350,000 to 900,000 new cases annually in the United States during or after hospitalization. An additional 1 million estimated VTE cases are not related to hospitalization.
  • VTE is deadly. Patients with a pulmonary embolism, when a blood clot travels to the lungs, have a 30 percent to 60 percent to chance of dying from it. Lower-extremity DVT has a 3 percent mortality rate, associated with blood clots that travel from the legs to the lungs.
  • VTE is preventable. Best practice prophylaxis reduces VTE incidence by an estimated 70 percent.
  • VTE frequently has complications. As many as 60 percent develop conditions such as postthrombotic syndrome, a long-term complication that causes pain, swelling, discoloration and, in serious cases, ulcers in the affected limbs.
  • VTE is recurrent. Between 10 percent and 30 percent of people who survive an initial VTE develop another one within five years.
  • VTE treatment is costly. Each DVT costs $10,000 and each PE costs $16,000, according to the Agency for Healthcare Research and Quality.

See our Strategies for Venous Thromboembolism Prevention

Patient Information

 

Patient VTE Information Handout

The Johns Hopkins Venous Thromboembolism (VTE) Collaborative has developed an educational handout to better engage patients and their loved ones as partners in preventing blood clots.

 

VTE FAQs

Content from the handout is adapted below. 

  • Blood clots are called venous thromboembolisms (VTE). There are two main types:

    • Deep vein thrombosis (DVT) is a clot in a deep vein, usually an arm or leg
    • Pulmonary embolism (PE) is a clot that has broken off and traveled to the lungs. This can cause death.

  • VTE kills over 100,000 people every year in the United States. This is more than the number of deaths caused by AIDS, motor vehicle collisions and breast cancer combined.

    VTE can cause problems that may affect you for the rest of your life. You may have:

    • long-term problems with breathing
    • a higher chance of getting another clot
    • swelling that will not go away
    • sores or wounds that will not heal

  • Some people who have VTE may not have any symptoms.

    People with DVT may have the following in an arm or leg:

    • swelling
    • pain or cramping
    • redness, tenderness or warmth

    People with PE may experience:

    • shortness of breath or are unable to catch their breath
    • pain in the rib cage area
    • coughing up blood

  • People who are in the hospital have a higher chance of getting a VTE. Other things that raise your chance of getting a clot:

    • previous DVT/PE
    • major surgery
    • trauma
    • obesity
    • recent stroke
    • family history of VTE
    • bedrest
    • varicose veins
    • blood diseases
    • pregnancy
    • cancer and/or chemotherapy
    • birth control pills and/or hormone replacement therapy

  • Depending on your situation you may have:

    • a blood test called a D-Dimer
    • an ultrasound of the arm or leg to look for the DVT
    • a CAT scan of the chest with intravenous dye to look for PE

  • When you come to the hospital, the care team will look at all the risks you may have to get a clot. They then order what is best for you, to help stop a clot from starting.

    • Medicines are the best way to stop a clot from forming. The 2 main medicines that are used to help prevent clots are heparin and enoxaparin (Lovenox). Some people call them blood thinners. These are shots that will be given to you usually in the belly.
    • Special stockings also can help prevent clots. Sequential Compression Devices (SCDs) use a machine and squeeze the legs or feet gently. They need to be on as much as possible to help prevent clots. You may also be ordered compression stockings or TED hose. These also help with blood flow.

    Although many people think walking around prevents blood clots, this is not true. Moving around and walking are important to keep you well and can help prevent things like pneumonia and bedsores. Walking by itself does not prevent clots. This is why your care plan should also include medications and/or SCDs and/or compression stockings your care team has ordered.

  • Depending on your specific condition you may need:

    • an IV medicine such as heparin
    • to take shots such as enoxaparin (lovenox)
    • to take pills such as warfarin (Coumadin), rivaroxiban (Xarelto), or dabigatran (Pradaxa)
    • to take these medicines for months or possibly your whole life
    • to wear special stockings such as TEDs which can decrease your risk of long term problems that can be caused from having clots
    • a special filter placed in a vein to “catch” the blood clot if it breaks free. Many of these can be removed after the danger from these clots have passed

    • Educate and Learn in the same minute. Listen to VTE collaborative team member and nurse educator, Dauryne L. Shaffer, share her experience with educating patients about VTE.
    • Watch videos

 

Video Gallery (Slideshow)

How Do I Prevent Blood Clots?

Blood clots claim more over 100,000 lives yearly in the United States. Yet as serious a health issue as blood clots are, studies have shown at-risk patients often don’t receive treatments known to help prevent them.

National Blood Clot Alliance Stop the Clot

The National Blood Clot Alliance (NBCA) is a non-profit, voluntary health organization dedicated to advancing the prevention, early diagnosis and successful treatment of life-threatening blood clots such as deep vein thrombosis, pulmonary embolism and clot-provoked stroke.

     
     

    Johns Hopkins Venous Thromboembolism Symposium

    The VTE Collaborative, with support from the Armstrong Institute and Department of Medicine, holds a VTE Symposium every March that highlights some of the latest research on venous thromboembolism and features a keynote speaker who is a national authority in this field.

    See past presentations
      

    Our Team

    Formed in 2005, the Venous Thromboembolism (VTE) Collaborative provides evidence-based standards for venous thromboembolism risk assessment, ordering and administration of patient-specific prophylaxis, while also advancing the science of blood clot measurement. Members include a hematologist, trauma surgeon, pharmacist, clinical informatician, intensive care nurse, nurse educator, medical writer/editor, human factors engineer and researchers.

    • Elliott Haut, M.D., Ph.D., F.A.C.S., Vice-Chair Quality, Safety and Service, Associate Professor of Surgery and Anesthesiology/Critical Care Medicine and Emergency Medicine, Johns Hopkins University School of Medicine; Core Faculty, Armstrong Institute for Patient Safety and Quality, Twitter: @ElliottHaut
    • Deborah B. Hobson, B.S.N., M.S.N., Safety and Quality Improvement Specialty in Surgery, The Johns Hopkins Hospital
    • Chris G. Holzmueller, B.L.A., Medical Writer/Editor, Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins Hospital
    • Peggy Kraus, Pharm.D., Anticoagulation Clinical Specialist, Department of Pharmacy, The Johns Hopkins Hospital
    • Brandyn D. Lau, M.P.H., C.P.H., Assistant Professor of Radiology and Radiological Science, Clinical Informatician at The Johns Hopkins University School of Medicine; Associate Faculty, Armstrong Institute for Patient Safety and Quality Twitter: @LauzeeTweet
    • Oluwafemi P. Owodunni, M.D., M.P.H., Post-Doctoral Research Fellow, Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins Hospital, Twitter: @Femiowodunni
    • Dauryne L. Shaffer, M.S.N., R.N., C.C.R.N., Nurse Educator, Department of Surgery, The Johns Hopkins Hospital
    • Michael B. Streiff, M.D., F.A.C.P., Associate Professor of Medicine and Pathology, Johns Hopkins University School of Medicine; Associate Faculty, Armstrong Institute for Patient Safety and Quality
    • Mujan Varasteh Kia, MPH, Research Assistant, Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins Hospital
    • Kristen L.W. Webster, Ph.D., Post-Doctoral Research Fellow, Human Factors Engineer, Division of Acute Care Surgery, Department of Surgery, The Johns Hopkins Hospital, Twitter: @LiseWelsh
     

    News and Publications

    Regularly featured in national media, the following is a collection of the outlets where the VTE Collaborative has helped advance public knowledge on blood clot prevention and measurement.

     
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