Huntington Hospital has taken an aggressive and unique step to prevent the number one cause of unexpected hospital deaths - deep vein thrombosis. A comprehensive Anticoagulation Management Service is tackling the problem of deep vein thrombosis (DVT) in joint replacement patients. Targeting these patients across the continuum of care - before surgery, in the operating room, during the post-operative period, through rehabilitation and after they return home - the service's goal is to prevent DVTs before they occur.

DVT is a blood clot that forms in a vein deep within the body, most often in the lower leg or thigh. Pieces of the clot can break off and travel to the lungs, causing a potentially fatal condition called pulmonary embolism (PE).

"There are two million DVTs a year in the United States and 600,000 PEs," said Carol Patrick, ACNP, Director of Anticoagulation Management Services. "Of these, 200,000 die from the condition."

Risk factors include being over the age of 40, being immobilized for long periods of time, surgery, a broken bone, or other trauma. Other risk factors are obesity, varicose veins, and having a prior clot or family history of DVT.

Huntington's effort is being coordinated by Kathleen Reed, RN, MS, ANP-C. Joint replacement patients meet Ms. Reed during their pre-surgical testing, when she assesses their risk for DVT and provides education about the condition, including prevention and recognition of symptoms.

The main preventative strategy is for patients to be on anticoagulation medications, more commonly known as blood thinners. Because these medications may also put patients at risk for bleeding, it is vital that they are closely monitored throughout the three-to-six weeks of anticoagulation therapy.

Ms. Reed oversees that monitoring during hospitalization following joint replacement surgery.. She then coordinates with rehabilitation centers to ensure that patients are appropriately monitored during their stay in rehab. Finally, when patients return home, Ms. Reed works with home care providers or patients directly to continue monitoring until therapy ends.

"Monitoring is done with a simple finger stick blood test, and results are available in 45 seconds," Ms. Reed noted.

Ms. Reed also communicates with patients' primary care physicians to ensure that all information regarding patients' conditions is available to everyone involved in providing care.

"We want to make sure that this issue is addressed throughout the full spectrum of care, from before surgery until the patient returns to their primary care physician," Ms. Reed said. "We especially focus on the transitions between levels of care - from hospital to rehab, and from rehab to home."

"Huntington Hospital is the only hospital on Long Island to invest the resources into this comprehensive approach to anticoagulation management," said James Gurtowski, MD, Chief of Orthopedics at Huntington. "It speaks volumes about our commitment to providing joint replacement patients with the highest standards of care and safety through our Center for Orthopedics and Joint Replacement."

For additional information on Huntington Hospital's Anticoagulation Management Services, please call (631) 351-2687.

Healthline February 2008