Deep vein thrombosis prevention
Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] Ujjwal Rastogi, MBBS [3]; Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet
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Deep Vein Thrombosis Microchapters |
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Diagnosis |
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Treatment |
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Special Scenario |
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Trials |
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Case Studies |
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Deep vein thrombosis prevention On the Web |
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Risk calculators and risk factors for Deep vein thrombosis prevention |
Overview
Primary prevention includes the strategies that help to avoid the development of disease. Awareness of Deep venous thrombosis is the best way to prevent this condition.
Primary prevention
Walking is an effective preventative measure.[1] It prevents backing up of blood in the lower limb vessels. Soleus is a powerful lower limb muscle which assist in walking. Also, in upright posture, it is responsible for pumping venous blood back into the heart from the periphery, and is often called the skeletal-muscle pump, peripheral heart or the sural (tricipital) pump.
Anticoagulants and mechanical measures may also be used. In 2012, the American College of Chest Physicians (ACCP) released their 9th edition of clinical guidelines,[2] which included recommendations on VTE prevention.[3] The recommendations were given strengths with "grades", depending upon the evidence for them.
| Grade | Description of 2012 ACCP grade[4] |
|---|---|
| 1A | Strong recommendation, high-quality evidence |
| 1B | Strong recommendation, moderate-quality evidence |
| 1C | Strong recommendation, low- or very-low-quality evidence |
| 2A | Weak recommendation, high-quality evidence |
| 2B | Weak recommendation, moderate-quality evidence |
| 2C | Weak recommendation, low- or very-low-quality evidence[5] |
Lifestyle modifications
The most common lifestyle risk factors for venous thromboembolism are:
- Obesity,
- Inactivity,
- Cigarette smoking,
- Avoid dehydration,
- Maintain normal blood pressure.
Surgery patients
Surgery patients are at an increased risk of forming a DVT.
I) In patients who have undergone non-orthopedic surgery, depending upon the risk of VTE, risk of major bleeding, and patient preferences, following are potential recommended treatments.
- Early ambulation (walking).
- Mechanical prophylaxis (intermittent pneumatic compression [IPC] or graduated compression stockings [GCS]).
- Drugs (low-molecular-weight heparin [LMWH], low-dose-unfractionated heparin [LDUH])[6]
II) In major orthopedic surgery patients—those undergoing total hip replacement, total knee replacement, and hip fracture surgery—additional drug options, such as fondaparinux and aspirin, are recommended (1B), though LMWH is preferred (2B or 2C).[7] IPC is an option (1C).[7][8]
Pregnancy
The risk of VTE is increased in pregnancy by about 4-fold[9] due to a more hypercoaguable state, a likely adaptation against fatal postpartum hemorrhage.
Travelers
There is clinical evidence that suggest, wearing compression socks, on long haul flights, reduces the incidence of thrombosis. A randomised study in 2001 compared two sets of long haul airline passengers, one set wore travel compression hosiery the others did not. The passengers were all scanned and tested to check for the incidence of DVT. The results showed that asymptomatic DVT occurred in 10% of the passengers who did not wear compression socks. The group wearing compression had no DVTs. The authors concluded that wearing elastic compression hosiery reduces the incidence of DVT in long haul airline passengers.[10].
Related Chapters
References
- ↑ Perry, Anne Griffen (2010). Clinical Nursing Skills and Techniques. St. Louis, MO: Mosby. p. 243. ISBN 978-0-323-05289-4.
- ↑ "Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. American College of Chest Physicians. 141 (suppl 2). 2012.
- ↑ Kahn SR, Lim W, Dunn AS; et al. (2012). "Prevention of VTE in Nonsurgical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (suppl 2): e195S–e226S. doi:10.1378/chest.11-2296. PMID 22315261.
- ↑ For more detailed text descriptions of the grades, including benefits vs. the risks and burdens, the methodologic strength of supporting evidence, and implications, see Table 4 of Guyatt et al., p. 62S
- ↑ Guyatt GH, Norris SL, Schulman S; et al. (2012). "Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (suppl 2): 53S–70S. doi:10.1378/chest.11-2288. PMID 22315256.
- ↑ Gould MK, Garcia DA, Wren SM; et al. (2012). "Prevention of VTE in Nonorthopedic Surgical Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (suppl 2): e227S–e277S. doi:10.1378/chest.11-2297. PMID 22315263.
- ↑ 7.0 7.1 Falck-Ytter Y, Francis CW, Johanson NA; et al. (2012). "Prevention of VTE in Orthopedic Surgery Patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (suppl 2): e278S–e325S. doi:10.1378/chest.11-2404. PMID 22315265.
- ↑ Kakkos SK, Caprini JA, Geroulakos G; et al. (2008). Kakkos, Stavros K, ed. "Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients". Cochrane Database Syst Rev (4): CD005258. doi:10.1002/14651858.CD005258.pub2. PMID 18843686.
- ↑ Marik PE, Plante LA (2008). "Venous thromboembolic disease and pregnancy". N Engl J Med. 359 (19): 2025–33. doi:10.1056/NEJMra0707993. PMID 18987370.
- ↑ Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet 2001;12(9267):1485-9. PMID 11377600.