DVT Prophylaxis-1

DVT Prophylaxis-1 - Prophylaxis Pt I DVT Prophylaxis in the...

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Unformatted text preview: Prophylaxis Pt. I DVT Prophylaxis in the SICU Gabriel Brat, MSIII 6/18/2007 Introduction • Importance of DVTs • Risk Factors • Methods of Prophylaxis • Recommendations • Compliance Bundles • PE third most common cause of iatrogenic death. • 2001 AHRQ report emphasized 1A evidence • IHI 5 million lives campaign—VAP bundle LE DUS for PE • 90% PE’s originate in lower extremity • 1st symptomatic DVT – Sensitivity 95%, specificity 96% – Increased sensitivity: • serial US at 5-7 days • combining with clinical suspicion Lower Extremity Veins Iliac ( Superficial) Femoral Deep (Common) Femoral External Saphenous Internal Saphenous Popliteal Hauer. UCSF 2005 Risk Factors for DVT Surgery Trauma (major or lower extremity) Immobility Paresis Malignancy Cancer therapy (hormonal, chemotherapy, or radiotherapy) Previous VTE Increasing age Pregnancy and the postpartum period Estrogen-containing oral contraception or hormone replacement therapy Selective estrogen receptor modulators Acute medical illness Heart or respiratory failure Inflammatory bowel disease Nephrotic syndrome Myeloproliferative disorders Paroxysmal nocturnal hemoglobinuria Obesity Smoking Varicose veins Central venous catheterization Inherited or acquired thrombophilia Risk of DVT Patient Group DVT Prevalence, % Medical patients 10–20 General surgery 15–40 Major gynecologic surgery 15–40 Major urologic surgery 15–40 Neurosurgery 15–40 Stroke 20–50 Hip or knee arthroplasty, hip fracture surgery 40–60 Major trauma 40–80 Spinal cord injury 60–80 Critical care patients 10–80 Geerts et al.Chest, 2004;126:338S Inherited Hypercoagulability Prevalence DVT Population Prevalence Factor V Leiden 12-21%** 6% Prothrombin mut 6-8% 2% Protein C, S def 2-4% < 1% AT III def 1-2% <1% All Thrombophilia...
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DVT Prophylaxis-1 - Prophylaxis Pt I DVT Prophylaxis in the...

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