Washington, DC - The Office of the Surgeon General called today for a coordinated, multifaceted plan to reduce the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the US [1]. The "call to action" is intended to increase awareness about these silent conditions and emphasizes the importance of evidence-based practices in the management of DVT.

Acting Surgeon General Dr Steve Galson announced the call to action at a press conference in Washington, DC, and noted that DVT and PE contribute to approximately 100 000 deaths each year. "To put this number into context, the population of Cambridge, MA is roughly 100 000," said Galson. "The number of deaths attributable to blood clots is like having an entire city, like Cambridge, wiped out each year."

"The good news," added Galson, "is that DVT and PE are preventable and treatable."

Published by the US Department of Health and Human Services, the Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism documents the major public-health problems DVT and PE pose, as well as strategies to reduce the risk of developing the conditions. The report highlights gaps in the awareness and application of evidence-based interventions and discusses the public-health response to reducing the incidence of DVT and PE.

In a concluding section on a vision for the future, the surgeon general asks stakeholders to take action to create a future where the public is knowledgeable about risk factors, triggering events, and symptoms of the disease; and where evidence-based practices for screening, prevention, diagnosis, and treatment of DVT/PE are routinely applied, and new scientific evidence is being discovered to fill in gaps in knowledge.

Drs Samuel Goldhaber (Brigham and Women's Hospital, Boston, MA) and Thomas Ortel (Duke University Medical Center, Durham, NC) are the scientific editors of the surgeon general's report.

The National Heart, Lung, and Blood Institute (NHLBI) collaborated with the office of the surgeon general on the call to action, and speaking to the media, Dr Elizabeth Nabel, director of the NHLBI, said the institute is committed to supporting research that focuses on understanding the causes of DVT and PE, as well as safe and effective detection methods, treatments, and preventive measures. Nabel said the NHLBI is set to launch the first multicenter, randomized, clinical trial of genotype-guided dosing of warfarin therapy.

"The study will examine whether the use of clinical plus genetic information during the initiation of warfarin can lead to better and safer treatment in patients, especially those with DVT, atrial fibrillation, who are at risk for stroke, or who require warfarin therapy following orthopedic surgery," said Nabel.

Another NHLBI-sponsored trial is the Acute Venous Thrombosis: Thrombus Removal With Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial, a study evaluating whether the use of pharmacotherapy in combination with a catheter-mounted thrombus-removal device can prevent postthrombotic syndrome (PTS) in patients with DVT. PTS develops when the thrombus continues to block the vein, damaging the one-way valves, and resulting in venous pooling, chronic leg pain, swelling, fatigue, and skin ulcers. The drug-and-device therapy is intended to break up the venous clot and then remove it from the vein to restore blood flow.

ATTRACT is led by Dr Suresh Vedantham (Washington University School of Medicine, St Louis, MO) and will enroll approximately 700 patients at 28 centers. The end points include the severity of PTS, quality of life, relief of pain and swelling, safety, and cost. Vedantham, along with Goldhaber, also leads the Venous Disease Coalition, which was formed in 2006 after a surgeon general's workshop on DVT.

In addition to the surgeon general's report, the Agency for Healthcare Research and Quality (AHRQ) has also developed two evidence-based DVT/PE resources, one for physicians and the other for patients [2,3]. The guide for clinicians is entitled Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement and is designed as a tool to "help hospitals and clinicians implement processes to prevent dangerous blood clots." The consumer resource, known as Your Guide to Preventing and Treating Blood Clots, is intended to help patients and their families learn about the causes, symptoms, and prevention of DVT.