ClotCare: Blood Clots, Stroke, Heart Attack
Friday, June 21, 2024
Home   |   DVT/PE   |   Blood Clots   |   Coumadin/Warfarin   |   New Patients   |   Self Testing   |   Email List   |   Donate

Pick a Topic:

Find info on a:

We subscribe to the HONcode principles of the HON Foundation. Click to verify.
ClotCare complies with the HONcode standard for trustworthy health
verify here.

ClotCare is a member of the Coalition to Prevent Deep Vein Thrombosis (DVT Coalition)  ClotCare is a member organization of the Coalition to Prevent Deep Vein Thrombosis. Click here to learn more about the Coalition to Prevent Deep Vein Thrombosis and DVT Awareness Month, which is held each March.

Potential Problems Created by Medicare's Decision to Make DVT and PE "Never Events" Following Hip or Knee Replacement Surgery

Henry I. Bussey, Pharm.D., FCCP, FAHA
April, 2009

As highlighted in 2008 on ClotCare (, the Center for Medicare and Medicaid Services announced a decision not to cover a deep vein thrombosis (DVT) and/or pulmonary embolus (PE) that results from hip or knee replacement surgery.

Drs. Streiff and Haut from Johns Hopkins University School of Medicine provide a critical analysis of the potential risks and benefits of implementing such a policy.1 In their analysis, they point out that implementing such a policy may:

  1. provide a disincentive to provide services to high-risk patients
  2. provide a disincentive to perform total knee or hip arthroplasty
  3. provide a disincentive to evaluate such patients for venous thrombosis when clinically suspected
  4. promote overly aggressive prophylaxis
  5. benefit only a minority of patients (citing data that only 8.6% of hospital associated venous thrombosis occur in this group of patients

Lastly, Streiff and Haut suggest that a more appropriate - and possibly more beneficial approach - would be to apply the policies recommended by the Joint Commission to see that all patients are evaluated for their risk of VTE and that appropriate prophylaxis is employed in such patients.

In addition to the issues raised by Streiff and Haut, other points that have been raised in discussions about the "never events" policy is that the policy may result in "gaming" the system by discharging and then readmitting those suspected of having a VTE so that the VTE could be diagnosed at the time of the second admission rather than during the surgical hospital stay. Others have raised the issue of whether diagnostic screening on admission might be employed in some patients to confirm the presence of an old clot prior to the surgery.

Clearly, implementation of this policy is likely to continue to generate further discussion.


Streiff MB, Haut ER. The CMS Ruling on Venous Thromboembolism After Total Knee or Hip Arthroplasty; Weighing Risks and Benefits. JAMA 2009 (Mar 11); 301(10): 1063-65.

Ask a question about blood clots or anticoagulant medications Have questions? Ask ClotCare. Send questions by email to

ClotCare is a 501(c)(3) non-profit organization generously supported by your tax-deductible donations and grants from our industry supporters.

Blood Clot Activities Calendar

New Postings:

Click here to view full list of new postings
ClotCare Home | New Postings | Patient Postings | Clinician Postings | Join Our Email List | Useful Web Links
CE Opportunities | Training Programs | DVT & PE Stories | Editorial Board | Financial Support
About ClotCare | DVT Coalition | Donate to ClotCare | Contact Us
Key topics discussed on ClotCare include: Blood Clots | Deep Vein Thrombosis (DVT) | Pulmonary Embolism (PE) | Atrial Fibrillation (A. Fib or AF) | Heart Attack | Stroke | Transient Ischemic Attack (TIA) | Mini Stroke | Bleeding Complications | Vascular Surgery | Surgical Blood Clot Removal | Warfarin | Coumadin | Lovenox | Low Molecular Weight Heparin (LMWH) | Heparin | Anticoagulants | Plavix | Aspirin | Antiplatelets | Blood Thinners
Copyright 2000-2018 by ClotCare. All rights reserved.
Terms, Conditions, & Privacy | Image Copyright Information
19260 Stone Oak Parkway, Suite 101 | San Antonio, TX 78258 | 210-860-0487
Send comments to
Friday, June 21, 2024