News

A startling 24,000 patients who undergo surgery in Canadian hospitals each year die after being struck down by what doctors call the silent killer: blood clots.

If those patients were provided with prophylactic blood thinners, most deaths could be prevented, according to Bill Geerts, a thrombosis specialist at the Sunnybrook Health Sciences Centre in Toronto. Those figures, he said, are extrapolations based on data from the United States.

"It's a bit embarrassing to have not fixed this problem by now," Dr. Geerts said in a telephone interview. "The evidence has been pretty compelling for a long, long time."

At a news conference today in Winnipeg, the Canadian Patient Safety Institute will announce an initiative to prevent venous thromboembolism - a blood clot in the vein that afflicts 80,000 hospital patients each year, including 24,000 who die from them.

As part of a campaign of Safer Healthcare Now!, a national group that helps implement safer health-care practices in hospitals, the institute will also announce efforts to thwart the spread of hospital-acquired superbugs, reduce falls in long-term care homes, and prevent adverse drug events.

The initiatives are a manual of sorts on how to stop inadvertently injuring and killing hospital patients.

"These are preventable deaths," Phil Hassen, chief executive officer of the Canadian Patient Safety Institute, said in a telephone interview from Edmonton. "That is what we are trying to say."

One patient who almost died from massive blood clots is Mary Bromley, 64, of King Township, north of Toronto.

The day after undergoing a right knee replacement at Holland Orthopaedic & Arthritic Centre in Toronto on `Jan. 19, 2006, she said she was short of breath, dizzy and semi-conscious.

During her hospital stay, she was provided oxygen intermittently. When the pain moved to her chest, she was given a liquid antacid. An X-ray of her chest was also taken.

When she was discharged on Jan. 25, 2006, "my first night at home was a nightmare, being short of breath with chest pain," Ms. Bromley said.

Still feeling awful one week later, she went to her family doctor, who immediately sent her for a CT scan. It revealed multiple pulmonary emboli, a particularly deadly condition when a blood clot inside a vein breaks off and travels through the bloodstream to an artery in the lung. She was treated with a blood thinner.

While Holland Orthopaedic & Arthritic Centre did provide her with a blood thinner after her knee operation in January, "the bottom line is that they never got me to the prophylactic level," Ms. Bromley said. "They never got me to that prevention of blood clot level."

Yesterday, John Murnaghan, an orthopedic surgeon at the Holland Orthopaedic & Arthritic Centre-Sunnybrook Health Sciences Centre, said he could not discuss Ms. Bromley's case due to patient confidentiality. However, he said it is routine to provide anticoagulants to patients undergoing a total hip or knee replacement.

According to Dr. Geerts, nearly all patients in hospital are at risk for blood clots and most hospitalized patients should receive the blood thinner as a preventive measure.

Those patients include most who undergo major general surgery, orthopedic surgery, neurosurgery and gynecological surgery, such as a hysterectomy. As well, most hospitalized medical patients and most or all intensive-care unit patients should receive it, he said.

Dr. Geerts said there are many reasons why blood thinners are not routinely provided as a preventive measure in the recommended doses. Doctors and other staff may not always appreciate a patient's risk factors.

But the main reason, he said, is that hospitals don't have a system in place to ensure doctors don't forget to order them.

Across Canada, more than two-thirds of acutely ill medical patients, half of all patients undergoing major general surgery and more than 20 per cent of hip fracture surgery patients do not receive the prophylactic anticoagulants, he said.

"It's an unacceptable complication," Dr. Geerts said. "The evidence is so overwhelming for doing this routinely that we can no longer accept being complacent about this."