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VTE. V enous T hrombo E mbolism. VTE – aims of this module. To define the terms associated with VTE and offer maximum care to treat patients. To enable patients to have greater understanding of their risks, and how to prevent venous thromboembolism. VTE – What does this include?.

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VTE

Venous ThromboEmbolism


Vte aims of this module
VTE – aims of this module

To define the terms associated with VTE and offer maximum care to treat patients.

To enable patients to have greater understanding of their risks, and how to prevent venous thromboembolism.


Vte what does this include
VTE – What does this include?

  • Deep venous thrombosis (DVT)

    • Below knee (distal)

    • Above knee (proximal)

    • Atypical (eg arm)

  • Pulmonary embolism (PE)

  • Cerebral venous thrombosis


Vte deep vein thrombosis dvt pulmonary embolism pe

Migration

PE

Embolus

Thrombus

VTE - deep vein thrombosis (DVT) & pulmonary embolism (PE)

DVT


Vte why does it happen virchow s triad
VTE – Why does it happen? (Virchow’s Triad)

Circulatory Stasis. (sluggish flow in the veins)

Endothelial injury to veins. (due to trauma or inflammatory processes)

Hypercoagulable state. (inherited or acquired pro-coagulant factors in the circulation)


Vte national context
VTE – national context

VTE is a major cause of morbidity and mortality in the UK

VTE deaths are 5 times more than total deaths from Hospital Acquired Infection, Ca Breast, RTA and Acquired Immune Deficiency syndrome.

60,000 die per year from VTE.

25,000 of these are hospital patients

Cost to NHS is £650 million


Vte acute consequences
VTE – acute consequences

Acute VTE symptoms in the patient

Painful, swollen leg

Acute breathlessness

Incapacity or sudden death

Time & money spent on investigation & treatment of a potentially avoidable condition


Vte chronic consequences
VTE – chronic consequences

  • Chronic VTE symptoms in the patient (25%)

    • Chronically painful, swollen leg

    • Leg ulcers & skin changes

    • Chronic breathlessness

    • Pulmonary hypertension

  • High risk of recurrence & therefore lifelong treatment with warfarin


Vte who is at risk
VTE - Who is at risk?

Most patients admitted to hospital Particularly where there is;

Immobility.

Dehydration.

Obesity

Advanced age

Acute & Chronic illness

Surgical intervention


Vte why risk assess
VTE – Why risk assess?

DocumentedRisk Assessment is vital as …

It alerts both the patient & healthcare team to VTE risk & triggers practical VTE prevention measures (eg hydration, mobilization)

Chemical +/- mechanical prophylaxis is highly effective at preventing VTE in high risk patients

It is a DoH requirement


Vte what is the risk
VTE – What is the risk?

  • Without thromboprophylaxis VTE may develop in:

    • Up to 50% medical patients

    • Up to 40% orthopaedic patients

    • Up to 20% surgical patients

  • Only ½ hospital patients at risk of VTE in the UK are getting targetted prophylaxis


Vte we forget because although the risk is high it is not immediate
VTE – we forget because although the risk is high it is not immediate

Mean time to develop a VTE after elective hip surgery? 22 days.

Mean time to develop a VTE after elective knee surgery? 10 days


Vte how to scale risk
VTE – how to scale risk not immediate

  • Low risk (eg. young, mobile patient)

  • High risk (eg. Immobile with any risk factor)

  • Very high risk (history of previous VTE)


Is the patient immobile with at least 1 risk factor for vte

What to do about VTE risk at SFT not immediate

Is the patient immobile with at least 1 risk factor for VTE?

YES

NO

Low risk

No specific action

High risk

Is LMWH contraindicated?

YES

NO

Very High = Both

Prescribe TEDS

Prescribe LMWH


Vte practical prevention
VTE – practical prevention not immediate

Adequate hydration.

Mobilisation as soon as possible

Regular leg exercises

Good positioning / posture / avoid hypothermia


Vte chemical prevention in patients at high risk
VTE – chemical prevention in patients at high risk not immediate

Low Molecular Weight Heparin (LMWH) Dalteparin 5000iu od @ 18:00

Oral Anticoagulant

THR or TKR for 5 weeks or 2 weeks

Rivaroxaban 10mg od @ 18:00


Vte lmwh contraindications
VTE – LMWH contraindications not immediate

  • Dalteparin is absolutely contraindicated in:

    • Patients at high risk of a serious / life threatening bleed

    • Major inherited bleeding disorders

    • Previous Heparin-induced thrombocytopenia

  • Other contraindications are relative (ie. balance of risk / benefit


Vte mechanical prevention
VTE – mechanical prevention not immediate

  • Mechanical compression devices (eg. Sequential compression devices - SCDs) must be used in theatre & can be carried on on the ward provided they are not off for >3hrs

  • Antiembolic stockings (eg. TEDs) should be used in High risk patients who cannot have chemical prevention or as an additional measure for patients who have previously damaged leg veins (eg DVT)


Vte contraindications to antiembolic stockings
VTE – contraindications to antiembolic stockings not immediate

  • Leg ulcers, peripheral vascular disease, peripheral neuropathy, lymphoedema

  • *** Badly fitted / applied stockings in patients with poor peripheral circulation can result in leg amputation


VTE - the (haemo)dynamic balance not immediaterisk must be regularly re-assessed – a bleed will physiologically trigger clot formation

BLEED

CLOT




Vte tell your patient about their risk
VTE - tell your patient about their risk not immediate

  • Verbally

  • Information leaflet

  • DVD / Video available on request


Vte more information
VTE – more information? not immediate

ICID – “Thromboprophylaxis”

DOH electronic learning tool

http://e-lfh.org.uk/projects/vte/launch/

[email protected]@salisbury.nhs.uk


Vte help prevent clots
VTE - Help prevent clots! not immediate

By kind permission of Richard Curtis and Tony Robinson


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