1 / 47

VTE/DVT Prophylaxis Orthopaedics

VTE/DVT Prophylaxis Orthopaedics. DVT-Thromboembolism. A thrombosis is a blood clot that blocks the normal flow of blood through an artery or vein. National Blood Clot Alliance, 274 people will die every day from the consequences of a blood clot.

saki
Télécharger la présentation

VTE/DVT Prophylaxis Orthopaedics

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. VTE/DVT Prophylaxis Orthopaedics

  2. DVT-Thromboembolism • A thrombosis is a blood clot that blocks the normal flow of blood through an artery or vein. • National Blood Clot Alliance, 274 people will die every day from the consequences of a blood clot. • 25 years of age as 85 years of age irrespective of gender. Result of a Traumatic injury, Surgical complication . HRT. Some birth control medications

  3. DVT-Thromboembolism

  4. What is DVT? Virchows triad vessel wall damage, stasis or low flow, and hypercoagulability.  These factors favor clot formation by disrupting the balance of the opposing coagulative and fibrinolytic systems

  5. Lower-limb deep venous thrombosis (DVT) affects between 1% to 2% of hospitalized patients. These thrombi disrupt the vascular integrity of the lower limbs and are the source of emboli that kill approximately 200,000 patients each year in the United States

  6. DVT-Thromboembolism • 10% of all DVTs are found in the upper limb and usually result from the use of catheters; surgery or trauma to the neck or shoulder. • Even sitting for long periods of time at work or at home in front of computer

  7. DVT-Thromboembolism • About 70% of patients referred for clinically suspected venous thrombosis, however, do not have the diagnosis confirmed by objective testing. Among the 30% who have venous thrombosis, about 85% have proximal vein thrombosis, and the remainder have thrombosis confined to the calf. • Venography • Ultrsounddoppler

  8. Common Iliac Vessel Thrombosis

  9. DVT-Thromboembolism

  10. Pulmonary embolism

  11. Pulmonary Embolism The warning signs and symptoms of a pulmonary embolism (or clot to the lung) include: • Shortness of breath that is sudden and unaccountable • Chest pain or discomfort that visibly worsens when you inhale deeply or when you cough • Feeling lightheaded and/or dizzy, or fainting • Fast heartbeat or rapid pulse • Coughing up blood Investigation:CT Pulmonary angiogram

  12. Pulmonary Embolism

  13. DVT Clinical Diagnosis • Symptoms of a DVT in the leg include swelling and cramping pain or soreness in the calf muscles. The skin over the area can become reddened or warm to the touch because of the underlying inflammation.

  14. DVT-Thromboembolism VTE risk factors include: • Major general surgery • Major orthopedic surgery • Lower-extremity paralysis due to spinal cord injury • Fracture of the pelvis, hip or long bones • Multiple trauma • Cancer — all cancers increase the risk, especially if the cancer has spread widely, cancer of the lung, brain, lymphoma, gynecologic system (like ovary or uterus), gastrointestinal tract (like pancreas or stomach). In patients with cancer, chemotherapy and surgery for cancer further increase the risk.

  15. Additional factors: Combination of two or more cause VTE and could influence the type and duration of the prevention treatment. • Prior VTE— Patients with a previous episode of VTE have a high chance of recurrence. • Age—>40 years higher risk, risk doubles with each subsequent decade. • Obesity--- 2 times the risk of VTE /higher the weight, higher the risk. • Immobility— Prolonged immobility, long travel, combined with other major risk factors increases the likelihood of VTE. • Oral Contraceptives or estrogen treatment • Family history of VTE--- especially if this is in a first-degree relative (parent, sibling, child) • Physical inactivity • Genetic blood conditions that affect clotting Protein C, S deficiency/antiphospholipid syndrome/ Factor 5 Leyden Mutation

  16. DVT-Thromboembolism • Mechanical Prohylaxis from the day of admission Antiembolism Stockings (TED Stockings)- 6 weeks Foot pumps in Hospital

  17. TED Stockings

  18. Below knee Ted stockings

  19. TED Stockings are contraindicated Abnormal leg shape/deformity Severe leg Edema/Heart Failure PVD-Arterial Severe Sensory impairment Acute Stroke Skin-Fragile/Damaged/Ulcerated/RecentGrafts Allergy

  20. Flowtron Boots

  21. Chemical Thromboprophylaxis • Assess the Bleeding Risk and safety of administering S/C(Clexane) or Oral (Dabigatran) Active Bleeding/ At Risk Inherited or Acquired Bleeding Disorders Anticoagulants- Warfarin/Heparin/Clopidogrel Platlets <75 Cr Clearance <30ml/mnt Hypertension>230/120 Heparin induced Thrombocytopenia LP/Epidural insitu/SA within last 4hrs

  22. Elective Hip Replacement • Offer VTE prophylaxis to people undergoing elective hip replacement surgery whose risk of VTE outweighs their risk of bleeding. Choose any one of: • LMWH1 (for 10 days) followed by aspirin2 (75 or 150 mg) for a further 28 days. • LMWH1 (for 28 days) combined with anti-embolism stockings (until discharge). • Rivaroxaban • Consider apixaban or dabigatran etexilate if none of the options above can be used. • Consider anti-embolism stockings until discharge from hospital if pharmacological interventions are contraindicated in people undergoing elective hip replacement surgery.

  23. Elective knee replacement • Offer VTE prophylaxis to people undergoing elective knee replacement surgery whose VTE risk outweighs their risk of bleeding. Choose any one of: • Aspirin2 (75 or 150 mg) for 14 days. • LMWH1 (for 14 days) combined with anti-embolism stockings (until discharge). • Rivaroxaban • Consider apixaban3 or dabigatran etexilate4 if none of the options above can be used.. • Consider intermittent pneumatic compression if pharmacological prophylaxis is contraindicated in people undergoing elective knee replacement surgery. Continue until the person is mobile

  24. Apixaban Apixaban is recommended as an option for the prevention of venous thromboembolism in adults after elective hip or knee replacement surgery. • Rivaroxaban Rivaroxaban,, is recommended as an option for the prevention of venous thromboembolism in adults having elective total hip replacement or elective total knee replacement surgery.

  25. Fragility fractures of the Pelvis, Hip and Proximal femur Offer VTE prophylaxis for a month to people with fragility fractures of the pelvis, hip or proximal femur • Choose either: LMWH, starting 6–12 hours after surgery or fondaparinux sodium2, starting 6 hours after surgery, providing there is low risk of bleeding.

  26. Non-arthroplasty knee surgery VTE prophylaxis is generally not needed for people undergoing arthroscopic knee surgery where: • total anaesthesia time is less than 90 minutes and • the person is at low risk of VTE. Consider LMWH1 6–12 hours after surgery for 14 days for people undergoing arthroscopic knee surgery if: • total anaesthesia time is more than 90 minutes or • the person's risk of VTE outweighs their risk of bleeding. • Consider VTE prophylaxis for people undergoing other knee surgery (for example, osteotomy or fracture surgery) whose risk of VTE outweighs their risk of bleeding.

  27. Foot and ankle surgery • Consider pharmacological VTE prophylaxis for people undergoing foot or ankle surgery: • that requires immobilisation (for example, arthrodesis or arthroplasty); consider stopping prophylaxis if immobilisation continues beyond 42 days • when total anaesthesia time is more than 90 minutes or • the person's risk of VTE outweighs their risk of bleeding.

  28. Upper limb surgery • VTE prophylaxis is generally not needed if giving local or regional anaesthetic for upper limb surgery. • Consider VTE prophylaxis for people undergoing upper limb surgery if the person's total time under general anaesthetic is over 90 minutes or where their operation is likely to make it difficult for them to mobilise.

  29. Planning for discharge As part of the discharge plan, give patients and their family members or carers (as appropriate) verbal and written information on: • the signs and symptoms of DVT and PE • how people can reduce their risk of VTE (such as keeping well hydrated and, if possible, exercising and becoming more mobile)

  30. Planning for discharge Give people discharged with VTE prophylaxis and their family members or carers (as appropriate) verbal and written information on: • the importance of using VTE prophylaxis correctly (including the correct administration and disposal of pharmacological prophylaxis) • the importance of continuing treatment for the recommended duration • the signs and symptoms of adverse events related to VTE prophylaxis

  31. Planning for discharge • Ensure that people who are discharged with anti-embolism stockings: understand the benefits of wearing them • understand the importance of wearing them correctly • understand the need to remove them daily for hygiene purposes • are able to remove and replace them, or have someone available who will be able to do this for them • know what to look for if there is a problem – for example, skin marking, blistering or discolouration, particularly over the heels and bony prominences • know who to contact if there is a problem • know when to stop wearing them.

  32. Ensure that people who are discharged with pharmacological and/or mechanical VTE prophylaxis are able to use it correctly, or have arrangements made for someone to be available who will be able to help them.

  33. Take home message • Please ensure patient knows how to wear stockings. • Ensure thromboprophylaxis is understood. • Signs and symptoms of DVT/VTE Understood Breathlessness which is unusual to the patient Calf pain/ Tenderness/ thigh pain / lower abdominal pain Reduced saturations.

More Related