Dvt Prophylaxis
Running head: Preventing Venous Thromboembolism
Best Practice
A Comparison of Low Dose Heparin and Venous Foot Pumps in the Prevention of Venous Thromboembolism.
Introduction
Background and purpose: Venous thromboembolism (VTE) is a disease that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). It is a common, lethal disorder that affects both hospitalized and nonhospitalized patients, if overlooked, can lead to long-term complications. VTE results from a combination of hereditary and acquired risk factors. Vessel wall damage, venous stasis, and increased activation of clotting factors also known as the Virchow triad is the most common cause of VTE mainly DVT. According to the National Institute of Health on the consensus of prevention of pulmonary embolism, all hospitalized patients are to be stratified into low, moderate, high and highest risk levels and treated according to their level of risk. Surgical patients, especially hip and knee patients are classified as highest risk while patients under the age of 40 with minor surgeries lasting less than 30 minutes are considered low risk patients. The preferred form of prevention of VTE in the low risk group is early active mobilization while a combination of pharmacological and mechanical management is recommended for the highest risk group. In this review, we will focus on the effectiveness of Low Molecular Weight Heparin (LMWH) compared to pneumatic compression devices in the prevention of VTE in very high risk hip and knee surgical patients.
PICO Summary: The population included in this review comprised of surgical patients with hip and knee surgery. The intervention examined was the use of LMWH and pneumatic compression devices. The comparison is LMWH versus pneumatic compression devices and the outcome measured is VTE. Hence the question, in patients undergoing hip and knee surgery, does the use of LMWH, compared to pneumatic compression devices, reduce the rates VTE.
Best Practice
A Comparison of Low Dose Heparin and Venous Foot Pumps in the Prevention of Venous Thromboembolism.
Introduction
Background and purpose: Venous thromboembolism (VTE) is a disease that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). It is a common, lethal disorder that affects both hospitalized and nonhospitalized patients, if overlooked, can lead to long-term complications. VTE results from a combination of hereditary and acquired risk factors. Vessel wall damage, venous stasis, and increased activation of clotting factors also known as the Virchow triad is the most common cause of VTE mainly DVT. According to the National Institute of Health on the consensus of prevention of pulmonary embolism, all hospitalized patients are to be stratified into low, moderate, high and highest risk levels and treated according to their level of risk. Surgical patients, especially hip and knee patients are classified as highest risk while patients under the age of 40 with minor surgeries lasting less than 30 minutes are considered low risk patients. The preferred form of prevention of VTE in the low risk group is early active mobilization while a combination of pharmacological and mechanical management is recommended for the highest risk group. In this review, we will focus on the effectiveness of Low Molecular Weight Heparin (LMWH) compared to pneumatic compression devices in the prevention of VTE in very high risk hip and knee surgical patients.
PICO Summary: The population included in this review comprised of surgical patients with hip and knee surgery. The intervention examined was the use of LMWH and pneumatic compression devices. The comparison is LMWH versus pneumatic compression devices and the outcome measured is VTE. Hence the question, in patients undergoing hip and knee surgery, does the use of LMWH, compared to pneumatic compression devices, reduce the rates VTE.
References: Anderson, F. A., & Audet, A., (1988). Best practice preventing deep vein thrombosis and pulmonary embolism: a practical guide to evaluation and improvement School Center for Outcomes Research. Retrieved October 30, 2010 from www.dvt.org. Center for Disease Control. (2010) Deep Vein Thrombosis and Pulmonary Embolism. Retrieved October 30, 2010 from Spitzer, A.,… & Padgett, D. E., (2010). Thrombosis prevention after total hip arthoplasty: a prospective randomized trial comparing mobile compression device with Fordyce, M. J. F., Ling, R. S. M., (1992). A venous foot pump reduces thrombosis after total hip replacement: a randomized controlled trial Newhouse, R.P. (2007). Diffusing confusion among evidenced-based practice, quality improvement and research. JONA, 37(10), 432-435. Pitto, R. P., Hamer, H., Heiss-Dunlop, W., & Kuehle, J. (2004). Mechanical prophylaxis of deep- vein thrombosis after total hip replacement: a randomized clinical trial Santori, F.S., Vitullo, A., Stopponi, M.,& Ghera,S. (1994). Prophylaxis against deep-vein thrombosis in total hip replacement: comparison of heparin and foot impulse pump, Thrombosis and Embolism Consensus Conference. (1986). Preventing of venous thrombosis and pulmonary embolism Appendix A Levels of thromboembolism risk in surgical patients and successful prevention strategies (Mathias 2006) * Rating quality of study (Newhouse et al., 2007) Level: