Screening Patients for Blood Clots Best Done Before Referral to Rehab
By Susan Christensen
Health and Research News Service
This setback is so common that rehabilitation physician Dr. Stuart Yablon was driven to learn more about the factors that influence venous thromboembolic disease in people with acquired brain injuries.
His latest findings suggest that hospitals would be wise to screen acquired brain injury patients for blood clots before they are discharged to a rehab setting.
“Our research indicates that a number of patients were leaving acute care with undiagnosed blood clots,” said Dr. Yablon, director of the Brain Injury Program at Methodist Rehabilitation Center. “Not only does this put the patient at risk for possibly deadly pulmonary embolism, but it also delays treatment and can lead to increased rehabilitation costs.”
The study analyzed the experiences of 180 acquired brain injury patients with deep vein thrombosis admitted to Methodist Rehab over a nine-year period. In the first three years, patients left the acute care setting without routinely being screened for blood clots, and 55 percent of patients with blood clots were not known to have this problem before admission to Methodist. Over the next six years, patients were screened for blood clots by the acute care hospitals, particularly at the University of Mississippi Medical Center–a practice that prompted a precipitous drop in the number of newly diagnosed deep vein thrombosis cases at Methodist Rehab.
“They dropped from 66 percent in the first year of the study, all the way to zero percent last year,” Dr. Yablon said. “The trend was highly significant. This highlights the importance of screening patients in the acute care setting because it significantly reduces the number of people who have blood clots we don’t know about.”
“When the problem is identified earlier, onset of treatment is hastened, presumably reducing patient morbidity, therapy interruptions and rehab costs.”
Dr. Yablon said the study also found that the risk of venous thromboembolic disease is greatest early after acquired brain injuries. “The period of increased risk declines as recovery proceeds and is consistent with a transient ‘hypercoagulable state’ after acquired brain injuries,” he said.
The screening study was presented at this year’s American Congress of Rehabilitation Medicine in conjunction with collaborators from the University of Mississippi Medical Center, and is the latest in a series of investigations that Dr. Yablon has conducted concerning venous thromboembolic disease.
His earlier research contradicted the popular belief that prolonged bed rest is the most important factor contributing to venous thromboembolic disease for brain injury patients. He also found that the prevalence of venous thromboembolic disease is higher among patients with brain tumors and intracranial hemorrhage than those with traumatic brain injury.