1.42 Venous Thromboembolism

Question 1

List common patient related factors for VTE

Answer 1

1. Age >60
2. Continous long distance travel prior to or post surgery
3. Prev hx DVT
   / FH VTE
4. Acute illness requiring CCM
   - sepsis resp failure

5. Surgery
Anaes + surgical time >90 min
Pelvic or LL surgery
Acute surgical admission
inflamm / intra abdo collecting

6. Obesity
   >30
7. Pregnancy

Question 2

RF VTE

Answer 2

8. Dehydration
9. Drugs
   -OCP
   HRT
10. Cancer +/- chemo radtx
11. VV w/ phlebitis
12. Immobility
    -neuro deficity
    bed rest
13. Cardiac disease
    - infarct / failure
14. Prolonged presence CVC
15. less common
    activate protein c resisiatance
    Protein C / S deficiency
    APL

Question 3

Thromboprophylaxis

Answer 3

Thorough assessment of patients to identify risk:

Drugs

Mechanical Devices

Early mobilisation

Question 4

Prophylaxis

drugs

Answer 4

Stop high risk drugs
OCP / HRT
4/52 before

2 Risk benefits of stopping antiplatelets

3 LMWH

4 Alternatives
- fondaparinux / dabigatran

5. UFH
   required in those w/ valves who take warfarin
   or renal failure
6. MDT approach
   incl GP
   Ongoing post-op VTE prophylaxis

Question 5

Prophylaxis

Mech devices

Answer 5

1. Anti thromboembolic stockings for all surgical patients
   unless c/i PVD / Active lower limb infection / neuropathies
   single use
   measured to fit
2. Foot impulse devices
3. Intermittent Pneumatic calf or ankle pumps
4. IVC filter
   ++ risk

Question 6

Prophylaxis

Answer 6

Other

1. Early post op physiotherapy
   encourage mobility
2. Avoid dehydration
   - supplemental iv fluids prn
3. Consider regional
   evidence ↓ risk VTE