Written evidence submitted by Thrombosis UK (PHS0326)

Venous Thromboembolism (VTE)

Why is this a big problem?

Venous thromboembolism, often known as ‘blood clots’, refers to deep vein thrombosis (DVT) and pulmonary embolism (PE).

Blood clots are common, the third most common cardiovascular disease affecting 2-3 per 1000 population per year. Anyone can be at risk of VTE regardless of age, gender, or ethnicity, however clots are a major risk factor in:

-          Obesity

-          Immobility

-          Pregnancy

-          Use of the oral combined contraceptive pill

-          Use of oral hormone replacement tablets

-          Increasing age

Yet most blood clots could be prevented – we need to make prevention a priority.

Blood clots causes significant mortality, while reported deaths are significantly under-reported. Death rates are rising with 16,000 deaths in 2021. Blood clots are the third most common cause of death from cardiovascular disease.

Clots causes significant chronic morbidity (long term ill health) in all age groups, including, post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension (CTEPH) and long-term psychological consequences[1].

As a result, VTE is associated with large healthcare costs.  Where direct healthcare costs have been estimated, such as in the US, these are huge, predicted at between $13.5 and $69.5 billion annually.

In 2021 preventing VTE became an NHS Patient Safety priority, but a public awareness campaign is needed as rates of deaths and harm due to clots continues to rise.

Why do we need to do something about it now?

Deaths secondary to VTE have not fallen for the last 10 years and in 2021, during the pandemic, they actually rose.

Many deaths caused by a blood clot could have been prevented, we know there is an opportunity for improvement, but we are not seizing it.

NHS England is the global leader in reducing preventable deaths due to blood clots associated with hospital admission (known as hospital associated thrombosis) because there is a mandated systematic approach to prevention every time an adult is admitted to an English hospital, but we need to look wider and include prevention of VTE in the community.

We know risk factors; we can identify high risk groups, but we are failing to promote public awareness to support primary prevention and improve early detection. As a result, we have an epidemic of preventable deaths and chronic morbidity.

How could we make a change?

Preventing disease - VTE is preventable in many cases

(i)                  Hospital associated thrombosis (HAT) accounts for 50%-55% of all VTE events but we prevent many in NHS England. Those who do to go on to get a clot will usually develop one post discharge from hospital.

(ii)                 Many blood clots occurring in the community are due to known provoking factors:

• Immobility
• Pregnancy
• Use of the oral combined contraceptive pill and
• Use of oral hormone replacement tablets
• Acute infection

Improving awareness on risk and how to reduce risk – including mobility, hydration, maintaining a healthy weight, and adherence to prescribed medication, are key factors in achieving blood clot prevention.

Public knowledge of risk factors, and how to reduce them, are key to improving prevention.

A strong public awareness campaign can provide this.

Preventing harm - prompter recognition and treatment could reduce the harm experienced by patients who develop VTE

-          People who die unexpectedly of a blood clot reveal that they often complained of nagging symptoms related to a pulmonary embolism for weeks before death.

-          40% of these patients had presented to a healthcare setting in the weeks before deaths[2] [3].

-          It is likely that many of these deaths could be prevented.

We are missing the diagnosis of almost half of those who die of PE because when they presented to a medical setting, blood clots were not considered or investigated. Whilst symptoms can be non-descript, unless investigated and VTE eliminated, risk of death is high.

We need to improve understanding of the signs and symptoms of clots, so if individuals develop the symptoms, they recognise them and present early to hospital and health care professionals can treat them.

A public health campaign aimed to increase awareness of blood clots, including risk factors and symptoms is urgently needed to improve prevention, save lives, protect from harm, and reduce burden.

February 2023