Remarks at the Launch

The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism

Monday, September 15, 2008, 9:00 a.m.

Speakers (remarks as prepared)

Rear Admiral Steven K. Galson
Acting Surgeon General

Dr. Elizabeth G. Nabel
Director, National Heart, Lung and Blood Institute

Dr. Carolyn M. Clancy
Director, Agency for Healthcare Research and Quality  

Le Keisha Ruffin
DVT Patient

Dr. Galson

Good morning.

My name is Dr. Steve Galson; I'm the acting Surgeon General of the United States.

I am pleased to be with you today to announce the release of The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. 

Deep vein thrombosis, commonly known as DVT and pulmonary embolism are serious medical conditions that affect an estimated 350,000 to 600,000 Americans each year, and the numbers are expected to increase with the aging U.S. population.

DVT is a blood clot in a deep vein, most commonly in the lower leg or thigh.  In the most serious cases, DVT can lead to a pulmonary embolism, or PE, – when part of the blood clot breaks loose and travels through the bloodstream to the lungs, where it can block a lung artery, or, in some cases, cause death. 

Together, DVT and pulmonary embolism contribute to at least 100,000 deaths each year.

To put this number into context, the population of Cambridge Massachusetts is roughly 100,000. The number of death attributable to blood clots is like having an entire city, like Cambridge, wiped out each year.

DVT and PE are often referred to as “silent” conditions – they can occur suddenly and without symptoms. In nearly half of the cases, there are no apparent symptoms.

It is important for the public to be aware of these triggering events that increase the risk of DVT and PE.  Being hospitalized or confined to bed rest, having major surgery, breaking a leg, or even just traveling for several hours all increase the risk for DVT and PE.  

DVT and PE affect both men and women, and risk increases with age, especially after age 50.  Women who take hormones – either for birth control or menopausal therapy – are at increased risk. 

Pregnancy also is a risk factor. Smoking and being obese are other risk factors for these conditions. Some may develop DVT or PE because they have an inherited blood clotting disorder. 

The good news is that DVT and PE are PREVENTABLE AND TREATABLE.

Today’s Call to Action marks another step forward in the process of increasing the public’s awareness of the human and economic costs of DVT and PE.

Earlier steps included a Surgeon General’s Workshop on Deep Vein Thrombosis that was held in May 2006.

This workshop was co-sponsored by the National Heart, Lung, and Blood Institute, or NHLBI, part of the National Institutes of Health. I am pleased that NHLBI Director Dr. Elizabeth Nabel is here with me today.

As many of you know, the Venous Disease Coalition was formed shortly after the Surgeon General’s workshop on Deep Vein Thrombosis to represent a response of the healthcare community committed to this serious public health issue.

I would like to thank the Venous Disease Coalition – and Dr. Goldhaber and Dr. Suresh Vedantham for their leadership of the Coalition – for the work you are collectively doing on this issue and for hosting this very important event.

In the months that followed the workshop, NHLBI continued its scientific research and studies of DVT and PE, which contributed to the development of The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism.

I want to express my gratitude to some of the people who led the way in developing The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism.

• I especially appreciate the hard work and commitment of Dr. Nabel, and her colleagues at the National, Heart, Lung and Blood Institute,
• I want to thank the Scientific Editors, Dr. Sam Goldhaber and Dr. Thomas Ortel, for their tireless contribution to this Call to Action,
• My staff in the Office of the Surgeon General – specifically the acting Director of Communications, Dr. Mary Beth Bigley, and
• Past staff members of the Office of the Surgeon General – many who are here today.
• I would like to take a minute to recognize two of the participants from the Surgeon General’s workshop who are here with us today: Melanie Bloom wife of the NBC reporter David Bloom, who has made it her mission to educate the public about DVT, and Heidi Blongastainer, a patient advocate, who presented her story of having a pulmonary embolism to workshop participants.

Thank you – ALL – for your commitment and collaborative effort to produce this Call to Action.

While we have made a lot of progress in understanding how these conditions develop and how to prevent, diagnose, and treat them, that knowledge is not being applied systematically.

It is for this reason that I am releasing The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism which asks every American to join with me in a national effort to address DVT and PE and their consequences.

The Call To Action highlights the need for:

• First, the development of a coordinated strategy to improve awareness of DVT and PE;
• Second, better use of evidence-based practices;
• Finally, that we need additional research on causes, prevention, and treatment.

The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism is a working document to be used as a resource by anyone who can have an impact – anyone who can help reduce the prevalence of DVT and PE.

Stay active, maintain a healthy weight. Know the warning signs and talk to your doctor. Education is the first step in preventing DVT and PE.

Now, I would like to introduce you to one of the most valuable contributors to this Call to Action and a champion of federally-sponsored research in heart, lung, and blood diseases.

Dr. Elizabeth Nabel joined the NHLBI in 1999 as the Institute’s Scientific Director of Clinical Research and in 2005 became Director. Please join me in welcoming Dr. Nabel…

Dr. Nabel

Thank you, Steve. The National Heart, Lung, and Blood Institute is pleased to have collaborated with the Office of the Surgeon General on this Call to Action.

Since the Surgeon General’s 2006 Workshop, NHLBI has funded several new research programs on DVT and PE.  These include research on damage to veins and valves following DVT, and a study on improving the health and well-being of elderly patients at risk for dangerous blood clots.  This last study is co-funded by two other components of the National Institutes of Health – the National Institute on Aging and the Office of Dietary Supplements.

Other research is focused on innovative approaches to treating DVT to prevent long-term damage to the veins, using a state-of-the-art image-guided strategy to dissolve the clot.

I am pleased to inform you that NHLBI will soon launch the first multicenter, randomized, clinical trial of genotype-guided dosing of warfarin therapy, the most commonly used blood-thinning treatment. 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.

Our research program has complemented the efforts of the six established Thrombosis and Hemostasis Centers supported by the Centers for Disease Control and Prevention.

By sharing resources and data from the network's patient registry, we are significantly enhancing our Federal research investment in DVT, which we hope will ultimately reduce the toll from these debilitating and often deadly blood clots.

The Institute remains 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.

Although there are varying estimates of the numbers of cases of DVT and how they are counted, it is clear that we are dealing with a major public health problem. As you have heard from Surgeon General Galson, there are certain groups of people who are at higher risk of DVT and PE.

• Certain inherited blood disorders (such as factor V Leiden) can make your blood more likely to clot than normal.
• And, of course, smoking, obesity, and certain medications such as hormones, as Surgeon General Galson, noted.

It is important for people to be aware not only of these factors that increase risk – but, of course, it is also vital for people to recognize the symptoms of DVT and pulmonary embolism.  When symptoms do occur, they can be difficult to recognize or confused with other conditions, such as a muscle strain or skin infection.

Symptoms of pulmonary embolism include unexplained shortness of breath, fast heartbeat, sweating, and sharp chest pain, especially with deep breathing. Signs of DVT include pain or tenderness, swelling, increased warmth, or redness in the affected area.

As I said earlier, science has helped us learn a great deal about factors that increase the risk of DVT.  Research is also paving the way for more effective and safe treatments.

One ongoing NHLBI study – an investigation of the treatment of Acute Deep Vein Thrombosis with Alteplase – offers a snapshot of DVT research supported by the Institute.

As research continues and with today’s release of the Call to Action I am confident that we will see advances in science that will ultimately prevent DVT and PE. 

We all know that getting the word out and improving health care quality is a team effort. Joining us today, is Dr. Carolyn Clancy, Director of the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality.

Dr. Clancy will be unveiling two new publications that will complement the Surgeon General’s Call to Action and our collective efforts to fight dangerous blood clots. Dr. Clancy …

Dr. Clancy

Thank you Dr. Nabel. And thank you Surgeon General Galson for this important Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism and for the opportunity to announce today’s release of two new resources from the Agency for Healthcare Research and Quality.

AHRQ is the lead agency on improving the safety of health care. To achieve that goal, we develop practical evidence-based resources that patients and clinicians can use right now to make informed decisions about health care and medical treatments.

These resources we are releasing today are a 12-page consumer booklet and a 60-page guide for clinicians on preventing and treating dangerous blood clots. Both were developed from toolkits originally created by experts funded through AHRQ’s Partnerships in Implementing Patient Safety grant program.

AHRQ’s consumer booklet, titled Your Guide to Preventing and Treating Blood Clots, is an easy-to-read resource that helps patients, like Le Keisha, and their families identify the causes and symptoms of unwanted blood clots, learn tips on how to prevent them, and know what to expect during treatment.

The guide for clinicians, Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement, is a tool to help hospitals and clinicians implement processes to prevent dangerous blood clots. It includes case studies and details the process of starting, implementing, evaluating, and sustaining a quality improvement strategy to help prevent dangerous blood clots.

Free, single copies of these and all AHRQ publications, including a guide on using blood thinning medications to treat dangerous blood clots, are available by calling the AHRQ Publications Clearinghouse at 800-358-9295 or by sending an e-mail to AHRQPubs@ahrq.hhs.gov

It is now my pleasure to introduce to you an individual who is willing to share with you her own experience with DVT.

Le Keisha Ruffin is an aspiring poet, and has written motivational and spirit-filled prose for more than 15 years.

I think you will find her story quite compelling.

Ms. Ruffin

Thank you, Dr. Clancy.  And thank you Surgeon General Galson for taking action to increase the awareness of DVT and PE among the American public and among health care professionals.

If I only knew then what I know now……..If I only knew the symptoms of DVT and PE………Most individuals who have suffered from venous thromboembolism don’t get an opportunity to reflect…….they missed their opportunity to help raise awareness, and are now counted as a statistic! 

Deep Vein Thrombosis and its GRUESOME side effect, Pulmonary Embolism, claim more lives in a year than AIDS and Breast Cancer combined!  Fortunately, the Venous Disease Coalition and others are dedicated to increasing public awareness about treatment, and prevention. 

My first experience with Deep Vein Thrombosis and Pulmonary Embolism was at my desk at a nursing home that I worked for. I was 23 years old.  As I keyed in the codes for those two diagnoses, I asked the admissions coordinator (a licensed nurse) what type of diseases they were.  Following her explanation, I concluded that DVT and PE were diseases that really only affected the elderly.  Little did I know, nearly four years later, I would have a hands-on experience with DVT and PE!

My experience with Deep Vein Thrombosis and Pulmonary Embolism began on November 17, 2003.  After giving birth to my daughter, Caitlyn, I experienced a joy that I had never had before, and was honored that God had chosen me to be a mother. 

Shortly after Caitlyn and I came home from the hospital, I began to feel extremely ill.  My husband, Craig, took me to the Emergency Room on several occasions only to be told that the severe pain that I was experiencing was due to the fact that I gave birth via Cesarean Section.

Nevertheless, I continued to feel ill.  I was having pains so sharp in my chest and side that it felt like someone was literally stabbing me over and over again in the same spot.  I actually told Craig that I felt like I was dying, yet, no one knew what was wrong with me.  So once again, Craig took me to the hospital, and once again, I was sent home!  However, in my gut, I knew that I needed help right away!

I often quote Oprah Winfrey who has spoken many times about gut feelings.  Oprah said that each time that she failed or succeeded in life, it was either because she obeyed, or ignored her gut feeling.

As I stand here today, I am grateful that I obeyed my gut feeling!  Now, you may not refer to it as a gut.  Some may call it an instinct, some may call it their inner voice, and some may call it a nudge, while others, like me, may call it the Holy Spirit!  Following my gut prompted me to make repeated trips to the Emergency Room, and it prompted me to pray.

As I began talking to God and praying, I told Him exactly what I was feeling.  I asked him to sustain my life because I wanted to continue to be a wife to Craig and I didn’t want my baby girl, Caitlyn, to grow up without a mother. 

On January 9, 2004, the pain that I was feeling intensified so greatly that I was having a difficult time walking. 

I called Craig at work and asked him to come home, because I couldn’t properly take care of Caitlyn.  When Craig came home from work, he ran what I call my “Miracle Bath.”  I call it my miracle bath because it provided a clue that would eventually help save me. 

The minute that I got into the bath that Craig prepared for me, I asked him to help me get out.  He then attempted to convince me to stay in for a bit longer, but I told him that I needed to get out right away.  As soon as he helped me out of the tub I passed out in his arms.  Shortly after, my right leg began to swell until it was 3 or 4 times larger than its normal size (the additional swelling occurred due to the heat that was applied while I was in the bath).  Soon after, Craig called for help and I was rushed via emergency vehicle to the nearest hospital.

After a few test, and being examined, the ER doctor informed me that I had a right lower extremity DVT (Deep Vein Thrombosis), which caused one of the largest blood clots that she had ever seen (one very large blood clot stretched from my calf to my abdomen).  Furthermore, she informed me that part of the blood clot had already broken off, traveled through my heart, and impacted my lungs causing a Pulmonary Embolism.  Finally, the ER doctor informed me that if I had not come into the hospital when I did, I may not have lived through the night.  I began to cry because I remembered the prayer that I prayed just a few days prior and knew that it was only by God’s grace and favor that my life was sustained. 

On January 13, 2004, I was transferred to a different health care facility where a few days later, I was rushed back to ICU and to the OR for an emergency surgery to protect my heart from further impact by the blood clot.  After being confined to the bed for nearly a month, I found out that I couldn’t walk.  I was given an order for physical therapy where I was given instruction on how to put one foot in front of the other, and I learned how to properly walk using a walker. 

I am extremely grateful to God because He honored my prayer and sustained my life!!  I am grateful to the awesome team of doctors who helped facilitate my care during my hospitalization.  I am grateful for organizations like the Venous Disease Coalition and to the Surgeon General, who help raise awareness about diseases such as DVT and PE.  Deep Vein Thrombosis and Pulmonary Embolism are preventable diseases.  Today, I encourage you to become aware of the risk factors for blood clots.  By logging on to www.venousdiseasecoalition.org and www.surgeongeneral.gov, you can become familiar with the warning symptoms—doing so will help protect you and your family, and possibly contribute to sustaining a life. 

This was a life changing event for me.  It is for this reason that I am pursuing my Master’s Degree in Counseling so that I can be there for those who have been challenged with this disease.  Thank you so much for your prayers of support as I pursue this.

My name is Le Keisha Ruffin, and I am a Deep Vein Thrombosis and Pulmonary Embolism survivor!  Thank you!

Dr. Nabel

Thank you Le Keisha.

I’d like to open up the press conference to questions from the media – here in the room and also on the phone.  We would appreciate it if only working press would ask questions. Please identify yourself and your news organization.  As you raise your hand, a microphone will be brought to you.  Reporters on the phone will receive instructions from the operator.

We are fortunate to have the two scientific editors of the Surgeon General’s Call to Action available to help answer your questions.  If I could ask Dr. Samuel Goldhaber and Dr. Thomas Ortel to join us on the stage, please.  Dr. Goldhaber is a Professor of Medicine at Harvard Medical School, a Senior Staff Member of the Cardiovascular Medicine Division of Brigham and Women’s Hospital and director of the Brigham’s Venous Thromboembolism Research Group.  Dr. Ortel is an Associate Professor of Medicine and Pathology at Duke University Medical Center.  He is also the medical director of the Hemostasis and Thrombosis Center at Duke.  We appreciate the efforts of Dr. Goldhaber and Dr. Ortel to bring the Surgeon General’s Call to Action to completion.

I want to thank everyone for participating today and I hope you will help to get the word out about this important public health issue. 

Reporters who would like additional time to interview Le Keisha Ruffin, Melanie Bloom, or Heidi Blongastainer can talk to them in the Wilson room just down the hall. Reporters on the phone can call 202-239-4032 to schedule an interview.

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