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Venous Thromboembolism:

Venous Thromboembolism:. Contemporary Management. Anthony J. Comerota, MD, FACS, RVT. Director, Jobst Vascular Center. Adjunct Clinical Professor, University of Michigan. Recovery. Death. Disability. Spectrum of Venous Thromboembolism. Management. Biologic onset. Asymptomatic.

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Venous Thromboembolism:

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  1. Venous Thromboembolism: Contemporary Management Anthony J. Comerota, MD, FACS, RVT Director, Jobst Vascular Center Adjunct Clinical Professor, University of Michigan

  2. Recovery Death Disability Spectrum of Venous Thromboembolism Management Biologic onset Asymptomatic Symptomatic Outcome Primary prophylaxis Screening Clinical suspicion Treatment

  3. DVT Prevalence: Hospitalized Patients Patient GroupDVT (%) Medical 10-20 General surgery 15-40 Major gynecologic surgery 15-40 Major urologic surgery 15-40 Neurosurgery 15-40 Stroke 20-50 Hip/knee arthroplasty, hip fracture surgery 40-60 Major trauma 40-80 Spinal cord injury 60-80 Critical care 10-80 Geerts WH et al. Chest 2004;126(3 suppl):338S-400S

  4. “Pulmonary embolism remains the most common preventable cause of death in the hospital.” Hull 1986

  5. Venous Thrombosis Risk Without Prophylaxis Risk Profile Outcome Risk Risk Factor Equivalents DVT* PE Low 0-1 <10% <0.01% Moderate 2-3 10-30% 0.1-0.5% High 4-5 30-40% 0.5-1.0% Highest >6 40-80% 1-5% Modified from: Geerts W et al CHEST 2001 * Includes calf DVT

  6. Venous Thrombosis Prophylaxis Risk Factor Equivalents 1 Factor Age 40-59 Bed Confinement >48 hrs Varicose Veins Leg Edema/ulcer/statis Obesity (>20% ideal wt.) MI (current) CHF (current) Severe COPD Crystalliods (>5L/24 hrs) Confining travel >4hrs Pregnancy/Postpartum (1 month) Inflammatory bowel disease Severe infection Estrogen Rx Operation >2 hrs

  7. Venous Thrombosis Prophylaxis Risk Factor Equivalents 2 Factors 3 Factors Age > 60 Stroke (current) Trauma Pelvic operation Joint replacement Hip fracture Malignancy Pelvic/long bone fracture Hypercoag. state Hx DVT/PE Spinal Cord Injury

  8. Rudolf Virchow Creator of Cellular Pathology 1821-1902 Presented the classic triad of the factors leading to DVT: • Venostasis • The hypercoagulable state • Vein wall injury

  9. The Beginning

  10. Stasis A “Permissive” Factor • “On table” phlebography • Decrease velocity • Decrease pulsatility • Retention of dye in valves • Radioactive NaCl studies • Decreased velocity • Femoral vein blood flow • Decreased up to 50% • Gen. Anes.

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