Root Cause of VTE Found
Scientists at the University of Pennsylvania have discovered a root cause of clot formation and venous thromboembolism (VTE).
The discovery revealed that recirculatory flow within the valve pockets of the legs activate a protective genetic program in the cells that line the pocket. This program stimulates the cells to alter the proteins they express to prevent clot formation. A patient’s lack of mobility while in the hospital severely limits this protective recirculatory flow, putting the patient at increased risk for VTE.
Read more about the study and its conclusions from the Journal of Clinical Investigation.
Blood clots frequently form in the legs of patients due to lack of mobility and the pro-clotting affects of primary clinical complications
- >70% of ALL hospital patients are considered at risk.
- There are 300,000-600,000 cases per year in the US, most in hospitals.
- This is the LEADING cause of preventable hospital deaths in the US (~100,000/year).
- Surviving patients face increased risk for future events and common lifelong complications.
- Approximately 1 in 5 patients are readmitted within 30 days.
- Hospitals are not reimbursed for treatment of hospital-acquired clots as they are considered preventable.
- These clots cost the Healthcare System $7-$10 Billion annually in the U.S.
Patient mobility is key.
But mobility isn’t always possible.
- Designed to optimize “active” flow across individuals with different sized feet
- Very low risk
- Open/breathable design
Challenges and Limitations of Current Standard of Care
Hospitals employ two strategies in an attempt to limit blood clots, improve patient outcomes, and save on treatment costs:
Mechanical compression – designed to increase venous blood flow to prevent blood “pooling.” This strategy is based on an abstract concept, not on science Devices are frequently uncomfortable and in poor compliance. Clinical data shows that there is little ability to prevent clots using mechanical compression (Ex: New England Journal of Medicine, 2019.) Learn more about mechanical compression here.
Chemical prophylaxis – This attempt to block blood clotting chemically is expensive, poses a significant risk of bleeding, and is often not appropriate for highest risk patients, such as those who’ve undergone surgery, traumatic injury, or stroke. And drugs are high risk. More than 4,500 law suits have been filed against the leading manufacture of anti-thrombotic drugs.
The impact of preventable DVT on hospitals is severe.
- Hospitals lose money paying for treatment for clots. They are penalized for poor patient outcomes and lose revenue from prolonged patient stays.
- Direct medial costs of $12,000 to $15,000 per clot diagnosis.
- Average patient stay for venous clots is 4 to 5 days.
- A hospital with 135,000 patients a year can face 700 treated venous clots, costing $10.5 million dollars in direct costs and 3,000 hospital bed days.
Our goal is for a 50% reduction of venous clot cases = $5.25 million in savings and 1500 hospital bed days!
More About The Study
The discovery of a specific hemodynamic requirement in the venous valve sinus to prevent loss of the perivalvular antithrombotic phenotype has immediate implications for the clinical approaches to DVT among high-risk patients, such as those in hospital for surgery and trauma. Present treatment and prevention of DVT consists of systemic anticoagulation and pneumatic compression devices designed to augment venous flow in the legs. Since many patients at the highest risk for DVT are also at high risk for hemorrhage due to recent surgery or trauma, systemic anticoagulation is often not an option. Pneumatic compression devices are widely used to reduce the incidence of DVT in hospitalized patients (42–44), but these devices have been designed and applied without a clear understanding of how changing venous hemodynamics might protect against DVT, and we observe only weak stimulation of perivalvular oscillatory flow with one such commonly used device. Thus it is likely that mechanical therapy could be significantly improved if it were targeted more specifically to reestablish the oscillatory flow in the venous valve sinus normally driven by muscular activity. Consistent with this notion, it has been appreciated for over 50 years that devices that provide electrical stimulation to the leg muscles during operative procedures — an approach predicted to more closely reproduce the hemodynamic effects of normal muscular activity — are highly effective in preventing DVT (although they are not well tolerated by conscious individuals) (45–47). Thus the creation of new mechanical therapies designed to specifically restore oscillatory flow in the venous valve sinus is predicted to improve the prevention of DVT in large numbers of high-risk individuals.