When good science, good medical care, and common sense sit athwart government bureaucrats, who wins? I think all of you know the answer, but it bears repeating.
One of the hidden dangers that lurk for patients -- particularly those who have undergone surgery or who have had trauma -- is the risk for developing a venous thromboembilism. I have written about this in the past, so I won't bore you with the details. Simply put, we try to aggressively treat patients with prophylactic measures to try to avoid the development of VTE, using medications (Heparin or Lovenox), early ambulation, and sequential compression devices. There are a few problems with this, however:
- Some patients cannot be mobilized, due to injury, ventilator-dependence, etc.
- Some patients cannot be given chemoprophylaxis, with injuries to the central nervous system, spleen, or liver which could bleed when they are given medications that interfere with clotting.
- Some patients will develop VTE, regardless of whether or not they are treated with appropriate prophylaxis.
In the May issue of Surgery News (link is to a pdf file), Dr. Jeffry Kashuk describes the test, known as rapid thromboelastography (r-TEG), using a device manufactured by Haemoscope. For those of you who are interested in the chemical processes involved, read the article for the details that were presented at the Central Surgical Association's annual meeting (which I suspect will be published formally in the not to distant future). The bottom line? -->
- 19% of the hypercoaguable patients experienced a thromboembolic event despite chemoprophylaxis, compared with none of the patients who had normal coaguability.
- Evidence of a hypercoaguable state predicted thromboembolic events with a 100% sensitivity and 45% specificity in patients who received chemoprophylaxis.
Whoa, Nellie. Stop right there. According to the
So, we know that some patients are at an increased risk for VTE, and some are going to get VTE even with currently appropriate prophylactic measures. This test may help us identify some of those patients, and start trials on treating them differently. CMS, ignoring the science and accumulated weight of decades of clinical evidence, by declaring this to be a "never event" has rendered this type of investigation moot, as they simply will not fund care for "never events."
Let this be a little introduction to government-run health care.