The greatest impact of new guidelines from the American Heart Association (AHA) that suggest additional therapies for treatment of more serious cases of DVT might be in prodding HM leaders to take ownership of existing standards to ensure greater compliance.
The review aims to help doctors “identify the severity of these disorders and to select who might be eligible for more invasive therapies, such as clot-busting drugs, catheter-based treatments or surgery,” M. Sean McMurtry, MD, PhD, co-chair of the writing group said in a prepared statement. The guidelines outline multiple treatment options, including the use of fibrinolytic drugs, catheter-based interventions, treatment with surgery to remove the blood clots and use of filters. Additional guidance for treating pediatric patients is included.
But Gregory A. Maynard, MD, SFHM, hospital medicine division chief at the University of California at San Diego, says most hospitalists deal with more routine cases of DVT and VTE than the research paper highlights. Physicians need to take more control of the existing patchwork of guidelines recommended by various research and established protocols, he adds.
“What’s missing in this paper … is how to make those things happen more reliably,” Dr. Maynard says. “To me, the hospitalist needs to look at guidelines like this and say, ‘How can we make them happen reliably?'”
For example, Dr. Maynard notes that for the treatment of iliofemoral DVT, it is recommended to both overlap warfarin and heparin, as well as have patients wear elastic compression stockings. Yet, he says, neither of those recommendations is routinely followed. In fact, he says of the former: “I would guess the percentage of patients getting these stockings is a distinct minority.”
And while that kind of reliability is tough to guarantee, it’s one of the cornerstones of SHM’s VTE prevention resource room and mentored implementation program.