Anybody can develop a deep vein thrombosis (DVT). It's a serious public health issue. But some are more likely to get this clot – or even die from it – than others due to differences in treatment.
According to estimates, DVT affects up to 900,000 people per year in the U.S. and about 100,000 die from it. Over half of the blood clots are related to a recent hospitalization or surgery. In fact, most clots develop after you’ve been discharged.
Studies show that DVTs affect people of color, especially those who are Black, differently. Black Americans are 30%-60% more likely than others to form a clot. If you’re Black, you also have higher odds of dying from it within 30 days. While experts aren’t exactly sure why, they believe barriers to timely DVT treatment and other inequalities in our health care system may play a role.
What Are the Common Treatment Disparities, or Differences, in DVT?
DVTs often remain undiagnosed and untreated, especially among people of color. In fact, one national online survey found that 1 in 3 people with recent DVTs experienced significant barriers to treatment.
Many things may affect your ability to get timely DVT care. Structural issues such as lack of knowledge, access to quality care, cost of treatment, and transport might pose a challenge. Systemic issues such as racial and ethnic biases within health care also affect the overall outcome.
Barriers to treatment include:
Lack of awareness. DVT is preventable. But to prevent it, you need to know what signs to look out for. Symptoms include swelling and redness. Know your risk for it, and get immediate help if you think you have a blood clot.
If your doctor knows you’re at risk to form a blood clot, they may monitor you, give you blood-thinning medications to prevent clots, or ask you to wear special tight stockings called compression socks to stop blood from pooling in your leg. These preventative measures are called prophylaxis. But health care providers don’t always teach you about DVT prevention or treatment during health visits or hospital care.
Cost of treatment. DVT treatment can be expensive. Blood thinners, also called anticoagulants, are the most common treatment for DVT. They can’t get rid of the clot but are designed to stop the clot from growing, breaking off, and to prevent new ones from forming.
If you have a DVT, you will need medication typically for 3-6 months. You’ll also need frequent follow-up visits depending on the type of medication. If your doctor is trying to prevent a DVT after a surgery or hospitalization, they may prescribe the medicine until you are discharged from the hospital and can get around as usual. Or you may need to stay on the medication longer under certain conditions.
Most health insurance companies and Medicare will cover DVT medication costs, but the drug prices vary widely. Older generations of blood thinners like warfarin (Coumadin, Jantoven) and heparin costs about $20-$70 for a 30-day supply. But newer-generation anticoagulants, also known as direct oral anticoagulants (DOACs), like apixaban (Eliquis), betrixaban (Bevyxxa), dabigatran (Pradaxa), and edoxaban (Savaysa) don’t have generic options. These drugs can cost around $300 or more for the same period of time.
If you have a massive blood clot, you may need to go to the hospital to have it surgically removed. Length of hospital stays can vary, and you may still need follow-up visits to manage your treatment plan. According to one study, blood clot care in a hospital, if you have insurance, costs about $7,758. If you don’t have insurance, it is closer to $12,297.
If you don’t have insurance, drug prices and other health care-related costs might be hard to afford out-of-pocket. Studies show higher drug costs also make it difficult to stick to the full course of treatment plan.
Racial and ethnic bias. Bias can impact the quality of your health care. Doctors or nurses may unknowingly hold biases that may influence their health care decisions.
In terms of DVT among hospitalized patients nationwide, research shows those who are Black are less likely to get a full course of anticoagulant therapy compared to white people or other ethnic groups.
Those who are Black also face other structural and systemic socioeconomic barriers to DVT treatment, such as lower household income and access to quality health care – especially if you live in rural areas – and lack of transportation.
Gender. If you’re Black, your chances of having pregnancy-related DVTs are higher. This is especially true if you have sickle cell trait, a common genetic blood disorder that affects 1 in 13 Black people. More research is required on routine DVT prevention methods during pregnancy, delivery, and after you give birth (postpartum).
Socioeconomics. Research finds that if you are considered low income, you are more likely to have PE and go back to the hospital within 90 days after the first time you get DVT care. This is because you’re more likely to face environmental risk factors such as:
- Lack of housing
- Lack of social support
- Poor medical knowledge
Location. Where you live might impact the quality of your DVT care. Studies show that Black individuals living in rural areas tend to get DVTs at a higher rate than those who live in urban areas. You’re also more likely to die earlier.
This may be due to lack of access to quality transportation. One study surveyed nearly 1,000 people with a history of DVT. One in 10 people said transportation was a significant barrier to DVT care.
What Is Being Done to Improve DVT Care?
Hospital-related DVTs or PE still make up more than half of blood clot cases. But it’s easy to prevent it with medications or leg compressions. Still, there’s no standard practice among doctors to screen for DVT risk factors.
To change this and prevent hospital related DVTs, the CDC plans to:
- Promote standardized methods and tools to monitor blood clots in the hospital
- Identify best practices to implement in DVT care inside hospitals
- Improve access to education on DVT risk factors and prevention
