The holiday season in full swing so many of us are buying those lovely stockings that prevent blood clots developing whilst we experience the delights of economy class long-haul travel. It is timely therefore that NICE (the National Institute for Clinical Excellence) has published new guidelines to help improve the diagnosis and management of these blood clots.
In 2010/11 over 56,000 people were diagnosed with blood clots in their legs or lungs. The difficulties in diagnosing these clots meant that, in 2007, nearly 17,000 of the recorded deaths in England and Wales mentioned clots in the leg or lungs as one of the causes of death. This is perhaps unsurprising when it is suggested that as many as 50% of people who have untreated blood clots in their legs will then develop one in their lung. Even if the clot is not fatal, it can cause long-term pain, severe swelling and disability. In extreme circumstances, where a clot in a leg has not been diagnosed, the leg may require amputation.
Blood clots in the legs do not just develop through ‘economy class’ syndrome. Factors such as clotting disorders, recent surgery or serious injury, obesity, general immobility and pregnancy can all increase your risk of developing these clots. Hospital patients are particularly vulnerable as they are less mobile than those in a community setting. NICE has therefore stated that ideally all patients who report symptoms of a clot should have blood tests and an ultrasound scan within 24 hours of reporting symptoms.
There is also a recommendation that everyone over 40 who has a clot diagnosed should be tested for cancer. As it can be a side-effect of cancer this testing may help diagnose people in the very early, and therefore more treatable, stages of the disease.
The guidance has also clarified the treatment of blood clots when they are diagnosed. Treatments include drugs to prevent clotting and, in certain circumstances, the use of anti-compression stockings for at least 2 years after the clot. Active follow-up of patients who have experienced clots has also been advised, particularly as those who have suffered previously are at greater risk of developing further clots.
Unfortunately we have dealt with many clients who did not have a clot diagnosed quickly enough. The moral of the story when it comes to clots is that caution is the wisest step. We therefore welcome the NICE guidelines which clarify the need for scanning within 24 hours, in order to identify and treat clots before they cause long term damage to a patient. Our hope is that these guidelines are applied across the NHS for the safety of all patients.