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VTE (Venous Thromboembolism) Venous thromboembolism (VTE)is a condition in which a blood clot forms most often in the deep veins of the leg, groin or arm (known as deep vein thrombosis, DVT) and travels in the circulation, lodging in the lungs (known as pulmonary embolism, PE). Epidemiology: •VTE is the leading cause of death & disability worldwide •900,000 cases per year in U.S. •Annual healthcare costs in U.S. estimated to be $7-10 billion Call to Action: US Surgeon General, Joint Commission, CMS, and ARHQ 1.One of the most preventable causes of death 2.2ndmost common medical complication related to hospitalization & extended length of stay 3.3rdcommon cause of excess hospitalization costs & high morbidity rates ** As age of population increases, so does the incidence of VTE
Objective 1: Identify the physiologic risk factors for developing VTE. Pathogenesis of VTE/Risk factors: (some of these will determine how long a patient will be on anticoagulant)Virchow’s Triad**Needs the following three in order to develop a clot (“it takes a village”) •Hypercoagulable state: •Circulatory stasis •Vascular Wall Injury •Medication induced: ▪Chemotherapy Tamoxifen (Nolvadex, Soltamox) Bevacizumab (Avastin) ▪Hormone Therapy (Birth control, estrogens, Steroids) •Genetic abnormalities ▪Factor V Leiden: Protein C or S deficiency (they don’t have Factor V so prone to throw a clot) ▪Prothrombin G20210A mutation •Antiphospholipid Syndrome People born with antibodies that promote blot clotting (autoimmune disorder) •Pregnancy ▪Baby itself can suppress the venous return causing blood clot ▪Hormonal changes •Malignancy *one of the highest risks of clot formation Cancer cells keep producing clotting factors •Atrial Fibrillation(blood pulling in the atria) ▪Blood is supposed to flow unidirectional from top to bottom but in A-fib, blood doesn’t flowproperly →clot will travel from upper chamber to lower chamber →Lower chamber pumps out clot & it will travel to brain/lungs/kidneys (causes STROKE) •Venous obstruction •Major Illnesses(CHF, Post-MI) ▪These conditions impair blood flow: weak heart cannot pump out enough blood →still point →clot •Immobilization▪Major surgery (gen. anesthesia >30 min) ▪Paralysis ▪Obesity •Concept for the ones listed above: If blood doesn’t circulate, clot will form •Polycythemia Vera •Too many RBCs that clump together →clot •Varicose Veins (If you get a cut/vascular injury, your body causes a clotting cascade activity) •Valvular disease/replacement •Major Orthopedic surgery ▪Knee/hip replacement * The most common in this section –if you have a hip surgery, how well are you going to be able to move post-surgery? Clot will form due to immobilization →Therefore if a patient is elderly, recommending surgery may kill the patient due to post-surgery complications •Trauma •Indwelling catheter •History of VTE **very important - HIGHEST risk especially within 3 months –if you’ve thrown a clot before, it is much easier to throw a clot again.
Risk of VTEs from Medications Drug ClinicalEvidence