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DVT Prophylaxis Deep Vein Thrombosis prophylaxis

Deep Vein Thrombosis Prophylaxis

Deep Vein Thrombosis

Deep vein thrombosis (DVT) occurs when a blood clot (thrombus) forms in one or more of the deep veins in your body, usually in your legs.

WHAT IS DVT?

  • Formation of a clot within a deep vein
  • Deep veins are embedded intramuscularly in the deep fascia
  • A clot begins as a small deposit of platelets, fibrin and red blood cells
  • Often originate in the venous valve cusp pockets
  • Thrombus extends and propagates

INCREASED RISK OF DVT

  • Travel > 4 hrs within 2-3 wks.
  • Strong family history.
  • Preganancy
  • Postmenopausal HRT.
  • Trauma to symptomatic limb < 60 days .
  • Hospitalization in previous 6 months

SURGICAL RISKS

  • Vein injury and trauma from surgery
  • Distension of veins
  • Anaesthesia
  • Stress response to surgery – elevation of pro-coagulant factors, fibrinolytic shutdown
  • Perioperative fluid loss – hyperviscosity
  • Specific intraoperative orthopaedic risk factors for THR/TKR (Capper 1998) -heat activated cement, tourniquet effect

SITES FOR DVT

  • Lower limbs
    • Venous sinuses of soleus muscle in calf
    • Femoral vein
    • Iliac vein
    • Upper limb its rare
    • Axillary vein following trauma, neoplasm

DVT DIAGNOSIS

Invasive  –  Ascending venography.

Non-invasive  –  Hand held Doppler,Directional Doppler, Doppler ultrasonography

  • Physical Methods: Plethysmography.Thermography.Radionuclidescanning.Fibrinogen I 125 uptake studies
  • Biological Methods: C – Reactive protein.,T-AT III complexes,Fibrinopeptide – A / TP antigen                 Circulating platelet aggregates,  Plasminogen activator inhibitor,  D – dimer.

PROPHYLATIC STRATEGIES FOR DVT

  • Pharmacological: Heparin, LMWH, Clexane
  • Non-Pharmacological
  • Intrinsic- walking
  • Extrinsic- Deep Vein Thrombosis  stockings, IPC[Intermittent Pnuematic Compression]

CLINICAL EFFECTS OF IPC

  • Increases or replaces calf muscle pump
  • Increase in blood flow (haemodynamics)
  • Increases arterio-venous (AV) pressure gradient
  • Decreases venous distension and venous pressure
  • Increases skin blood flow – tissue perfusion
  • Reduces oedema
  • Increases fibrinolysis (assists in breakdown of fibrin deposits)

 COMPLICATIONS OF DVT

Pulmonary embolism

Non healing leg ulcers

IPC: WHO AND WHEN???

Surgical patient:Pre-operatively,Intra-operatively,Post-operatively  for at least 72 hours or until patient is fully mobile (at least five minutes in every hour)

Non-surgical patient:Immediately upon identification that the patient is at risk

WHY IPC??

  • An alternative to other kinds of prophylaxis
  • May be used in conjunction with pharmacological prophylaxis in high risk patients – no problems of interaction
  • May be used with patients contraindicated for pharmacological prophylaxis e.g.: major bleeding disorders, increased risk of haemorrhage, gastrointestinal ulceration
  • Safe, absence of bleeding complications
  • Efficacious

CONTRAINDICATIONS FOR IPC

  • Severe arteriosclerosis or other ischaemic vascular diseases
  • Known or suspected acute DVT or phlebitis
  • Severe congestive cardiac failure
  • Pulmonary embolism
  • Any local condition in which the garments would interfere, including gangrene, recent skin graft, dermatitis or untreated, infected leg wounds