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NewYork-Presbyterian Launches Initiative To Prevent DVT

New York (Jun 15, 2009)

Stretcher in emergency room

NewYork-Presbyterian Hospital is launching an initiative aimed at reducing the incidence of potentially serious blood clots called deep vein thrombosis (DVT). The program involves evaluating the risk of DVT among all patients admitted to the hospital, those who come through the emergency room, and those who undergo outpatient surgery. Patients at risk of DVT are given appropriate medications to reduce their risk.

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Videos: These videos are from a DVT awareness event held at NewYork-Presbyterian with the Coalition to Prevent Deep-Vein Thrombosis. Dr. Robert E. Kelly, who reads the proclamation, is the Senior Vice President, Chief Operating Officer, and Chief Medical Officer at NewYork-Presbyterian/Columbia. Melanie Bloom, from the Coalition, is the widow of NBC News reporter David Bloom. Dr. Nicholas Morrissey is a DVT expert at NewYork-Presbyterian.


"Deep vein thrombosis and pulmonary embolism are the number one cause of preventable hospital death," explained Nicholas Morrissey, MD. "The goal of this program is to drive down the incidence of these disorders. Many hospitals are now taking a formalized approach to DVT prevention."

quote from article

Deep vein thrombosis (DVT) is a blood clot that forms in a vein deep in the body. These clots usually occur in the lower leg or thigh, but can occur in other parts of the body too. A pulmonary embolism occurs when a blood clot breaks loose and travels through the bloodstream to the lungs, where it can block a lung artery – causing damage to the lungs or other organs by depriving them of oxygen. DVT and pulmonary embolism affect up to 600,000 Americans each year – a number that continues to rise as the U.S. population ages – and contribute to at least 100,000 deaths annually.

Research has shown that about half of the people worldwide who should be receiving DVT prophylaxis are not getting it. The problem was serious enough for the U.S. Surgeon General to issue a call to action in September 2008 to prevent DVT and pulmonary embolism.

People with elevated DVT risk include those who:

  • Have a history of prior DVT.
  • Are on prolonged bed rest.
  • Have cancer.
  • Had major surgery.
  • Have a family history of blood clots or a clotting disorder.

Dr. Morrissey and other physicians worked over several months to create a DVT risk assessment tool which has been incorporated into the patient electronic medical record system. No action is needed for patients who are already on blood thinners. For those who are not on these medications, physicians answer a series of questions, the results of which are used to compute a DVT risk score. The doctor then places an order for a blood-thinning medication to prevent DVT – such as heparin or coumadin – for those patients determined to be at risk.

Many patients can go off the medication once they are up and around after a procedure. Those who have already had a blood clot may need to take it for several months.

Nicholas Morrissey, M.D.
Nicholas Morrissey, M.D.

Another key component of the initiative is education, with patients and their caregivers receiving literature and information about DVT and its prevention. Dr. Morrissey and his colleagues aim to study compliance with DVT prevention recommendations and to examine the DVT rate at each hospital before and six months to a year after implementing the initiative.

In addition, he hopes to influence Medicare policy. He explained that Medicare is paying less and less for health care delivered to treat DVT complications, and eventually may not reimburse hospitals for these treatment services at all. But he noted that is not realistic.

"A complication is not always a mistake and is not always preventable. It can be reduced but not eliminated. Even if every hospital provided DVT prevention to every patient who needed it, nature will never allow the DVT rate to go down to zero," Dr. Morrissey explained. "It may be more realistic to require hospitals to have DVT prophylaxis in place and set a target DVT complication rate. I hope our program at NewYork-Presbyterian can be a beacon of national policy in this area."

The DVT risk assessment tool is scheduled to be implemented at NewYork-Presbyterian Hospital in June. "We're not trying to take decision-making out of the hands of physicians," Dr. Morrissey concluded. "We're just encouraging them to think about DVT and to be safe."

Nicholas Morrissey, MD is an Attending Surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center, and an Assistant Professor of Surgery and Vascular Surgery at Columbia University College of Physicians and Surgeons.

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