ETHA Statement for Universal Health Coverage Day on 12 December

Universal Health Coverage Day is on 12 December. To recognize and help support this important day, the European Thrombosis and Haemostasis Alliance (ETHA), is sharing the following joint statement:

1 in 4 people worldwide are dying from conditions caused by thrombosis – the formation of a thrombus (blood clot) in a blood vessel. Prevention of thrombosis, an underlying pathology of heart attack, thromboembolic stroke, and venous thromboembolism (VTE), must be prioritised in the UHC pursuit of upholding quality of care in essential health services.

VTE is a condition in which a blood clot forms most often in the deep veins of the leg, groin or arm (known as deep vein thrombosis, DVT) and travels in the circulation, lodging in the lungs (known as pulmonary embolism, PE). Together, DVT and PE are known as VTE – a dangerous, potentially deadly medical condition.

VTE is the leading cause of adverse events due to hospital admission globally and its prevention could be essential in moving together to build a healthier world. The UN and WHO should act as a facilitators and disseminators of best practice evidence-based prevention, along with partners such as ETHA and the International Society for Thrombosis and Haemostasis (ISTH), an official non-state actor, standing ready to lend its expertise, resources and global network towards this goal. Prevention of hospital-associated VTE is symbolic of high quality essential health care and implementation of simple cost-effective evidence based best practice will lead to real healthcare cost-savings.

  • The WHO have shown that globally there are almost 10 million hospital-associated VTE annually.[i]
  • It is the leading cause of adverse events directly due to hospital admission in low, middle and high income countries.
  • It is the biggest cause of lost DALY (disability adjusted life years)[i] due to hospital admission in low and middle income countries.
  • VTE causes more hospital-associated adverse events than catheter-related sepsis, hospital-acquired pneumonia and falls.
  • VTE is associated with a high potential of morbidity and mortality in cancer patients[ii][iii] and is the second leading cause of death in cancer patients.[iv]
  • Overall VTE is the third leading cardiovascular diagnosis after heart attack and stroke.[v]
  • The Third edition of Disease Control Priorities: Volume 1. Essential Surgery states that delayed morbidities include blood clots and that anticipating potential complications, and preventing them (for example, by prophylaxis for venous thromboembolism) are essential to reduce these risks[vi].

All countries can reduce mortality from VTE

National health systems can reduce mortality from VTE by mandating VTE risk assessment for all hospital admissions and providing prophylaxis when required. Prevention of hospital-associated VTE requires very little additional time burden to hospital staff. Diagnostic and preventative methods are available at minimal cost and the most used prophylaxis medications are included on the WHO essential medicines list.

VTE risk assessment of hospital admissions is key to successful prevention and a marker of high quality healthcare

Hospital-acquired VTE is one of the most preventable causes of mortality related to hospital attendance. There are validated risk assessment tools to help identify those patients at risk – consisting of a short patient questionnaire which takes only minutes to complete. When systematic mandated risk assessment has been used (and prophylaxis administered when needed), it has resulted in a national reduction of death due to pulmonary embolism (PE), e.g. NHS England mandated risk assessments reduced deaths due to VTE related events within 90 days discharge from hospital by 15.4% VI. We therefore recommend using the NHS England risk assessment tool in view of its success.

Although hospital-associated VTE can occur in surgical patients, the majority of cases occur in medical admissions for non-surgical problems such as pneumonia and stroke and in pregnant women, so it is important all hospital admissions be assessed.

VTE prevention is cost-effective

In addition to disease burden, VTE causes significant global economic burden. VTE and related complications often lead to the need for multiple additional diagnostic tests and treatments, prolonged hospital stay and follow-up care, which can be extremely costly. This does not even consider lost work productivity due to post- or re-occurring thrombotic complications. By focusing on VTE prevention, healthcare systems can save money, improve outcomes and ultimately save lives. Some countries have already begun implementing VTE policies and protocols that standardise – and even incentivise – VTE prevention in hospitals.

As shown by National Institute for Health and Care Excellence in the UK, prevention of hospital-acquired VTE leads to real healthcare cost-savings. Estimates of the overall annual cost of VTE and its complications range from up to $1 billion in western-European countries[vii] to US$3 billion in the USA[viii].

How the UN and WHO can make an impact

Together, let’s:

  • Prioritise VTE prevention as a global UHC ask of upholding quality of care;
  • Disseminate a VTE risk assessment tool, model for use by health systems globally;
  • Produce accessible digital case studies and guidance to spread best practice and systems-approach solutions.
  • Encourage health systems to introduce mandatory contractual VTE prevention metrics and indicators as a marker of high quality healthcare

Committed partners

As a non-state actor in official relations with the WHO, the International Society on Thrombosis and Haemostasis (ISTH) and its members, which include 5,000 medical professionals as well as over 1,500 medical and scientific partners in 98 countries, as well as ETHA, stand ready to be committed partners in implementing these life-changing improvements to healthcare systems around the world.

[i] Jha AK, Larizgoitia I, Audera-Lopez C, et al, The global burden of unsafe medical care: analytic modelling of observational studies BMJ Qual Saf 2013;22:809-815.
[ii] Sorensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med. 2000;343:1846–50.
[iii] Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH, et al. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost. 2007;5:632–4.
[iv] Trousseau A. Plegmasia alba dolens. Lectures on clinical medicine, delivered at the Hotel-Dieu, Paris. 1865;5:281–332.
[v]http://www.heart.org/HEARTORG/Conditions/VascularHealth/VenousThromboembolism/What-is-Venous-Thromboembolism-VTE_UCM_479052_Article.jsp#.Wo6y1vll_X4
[vi] https://openknowledge.worldbank.org/handle/10986/21568
[vii] https://files.digital.nhs.uk/79/2031FC/nhs-out-fram-ind-feb-19-comm.pdfvii House of Commons Health Committee Report on the Prevention of Venous Thromboembolism in Hospitalised Patients. www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/99/9902.html.
[viii] Medscape. Medscape General Medicine. 2004:6(3)5.