Deep Vein Thrombosis (DVT)

Menstuff® has compiled the following information on Deep Vein Thrombosis (DVT). Resources

The Short Version

Deep vein thrombosis occurs when a clot obstructs the flow of blood in the leg. If the clot travels to the lungs, causing a blockage called a pulmonary embolism, it can be fatal: 60,000 Americans die each year from DVT. That's more than die from AIDS and prostate cancer (or breast cancer) combined (in the U.S.)

Risk Factors

Obseity, heart disease and dehydration. Also a factor is the limited movement caused by prolonged confinement in a car or airplace seat.

Symptoms

Leg pain (it may feel like a serious cramp) or swelling. If a clot travels to the chest, unexplained shortness of breath, discomfort, coughing and light headedness or blackouts.

Treatment

Often requires blood-thinning drugs, although an invasive procedure is sometimes needed. Stretching and drinking plenty of fluids can alleviate mild symptoms.

The most recent FDA cleared interventional therapies which, for some patients, can quickly resolve pain and swelling, restore blood flow and ultimately cost less than legacy treatments. www.dvtanswers.com

A Longer Introduction

For over a decade, we have been involved in projects to improve the use of prophylaxis for deep vein thrombosis (DVT) in Massachusetts hospitals. We want to share the lessons of this experience. The tools provided in this manual will help you to create a structured quality improvement program that can assist physicians and hospital quality assurance managers in evaluating and improving the use of DVT prophylaxis. Implementation of a system-wide process for preventing DVT will also help your hospital meet the JCAHO requirement for quality improvement activities.

Let us tell you why we believe that DVT prevention is important. Many healthcare providers are under the false impression that this life-threatening illness is not a problem in their hospital or among their patients. While it is true that an individual doctor will normally see relatively few patients with this disease, it is clear that DVT is an important public health problem. Each year, 600,000 patients will experience venous thromboembolism. Each year, at least 50,000 and perhaps as many as 200,000 patients will die from blood clots that obstruct blood flow to their lungs (pulmonary embolism). The tragedy is that most of these problems could be avoided by simple, cost-effective measures. Use of modern methods of DVT prophylaxis will reduce the incidence of DVT during the postoperative period by two-thirds and will prevent death from pulmonary embolism in 1 patient out of every 200 major operations.

Using prophylaxis for DVT is neither complicated nor expensive. In fact, several studies show that preventing this disease is cheaper than treating its consequences. Giving prophylaxis to those who are at risk should be a routine practice in your hospital. Basically, the approach to DVT prevention is similar to preventing postoperative wound infections. As with antibiotic administration, the keys to preventing DVT are in knowing who is at risk, when to apply the preventive measure, and applying the appropriate measure.

Thank you for taking the time to consider the benefits of instituting a DVT quality improvement initiative in your hospital. We know that your patients will benefit from your efforts.

We have created a companion Web site for this program at www.dvt.org which includes much of the material in this manual along with additional resources on diagnosis and treatment of venous thrombosis and pulmonary embolism.

Why is it important to prevent DVT?

The information in Chapter-1 has been compiled with the help of the Thrombosis Forum - an international group of physicians and scientists concerned about the morbidity and mortality associated with venous thromboembolism. It is intended to act as a starting bank of information that can be used by physicians and nurses when preparing lectures, seminars and workshops for hospital colleagues. This material is divided into five sections

Section 1: Venous thromboembolism - the need for prophylaxis

Section 2: What are we trying to prevent?

Section 3: Approaches to prevention

Section 4: The available methods of prophylaxis

Section 5: The cost effectiveness of prophylaxis

One of the most common causes of death in the hospitalized patient is pulmonary embolism (PE). Routine autopsies estimate that from 10 to 25 percent of all deaths in hospital involve emboli in the lung, many of which are extensive enough to be considered as having caused the death of the patient. In addition, some patients suddenly found dead in bed at home are also thought to be victims of massive, unforeseen PE.

While many of these individuals may have had a terminal illness leading to embolism, a significant number of deaths occur in patients who had comparatively minor ailments and who might otherwise have lived normal and healthy lives.

Death and morbidity

It is estimated that one in 100 patients admitted to a hospital dies because of PE. It appears possible than more than one-half of these at-risk patients could be saved if effective prophylaxis was used. For example, patients undergoing major operations without receiving prophylaxis are put at risk of fatal PE and stand an even greater risk of morbidity from related conditions.

In more than 90 percent of cases of PE, the thrombosis originates in the deep veins of the legs. Deep vein thrombosis (DVT) is itself a distressing but often avoidable condition that leads to long-term complications such as the post-phlebitic syndrome and chronic leg ulcers in a large proportion of patients who have proximal vein thrombosis.

Table 1.2 Venous thromboembolism - a serious and common problem that can and should be prevented

Source: www.outcomes-umassmed.org/dvt/best_practice

Resources: 
Comprised of more than 36 organizations—the Coalition to Prevent DVT has made great strides, since its formation two years ago, in educating the public www.chestnet.org/about/news_dvt.php
Find articles www.findarticles.com/p/articles/ mi_qa3940/is_200406/ai_n9433777, www.dvt.net
www.preventdvt.org
www.namcp.com/DVT.htm
www.clotcare.com/clotcare/dvtcoalition.aspx
www.dvtanswers.com/AboutDVT/about.html

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