Thrombosis prevention: Difference between revisions
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{{Thrombosis}} | {{Thrombosis}} | ||
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==Prevention== | ==Prevention== | ||
Thrombosis and embolism can be partially prevented with anticoagulants in those deemed at risk. Generally, a risk-benefit analysis is required, as all anticoagulants increase the risk of bleeding. In [[atrial fibrillation]], for instance, the risk of [[stroke]] (calculated on the basis of additional risk factors, such as advanced age | Thrombosis and embolism can be partially prevented with anticoagulants in those deemed at risk. Generally, a risk-benefit analysis is required, as all anticoagulants increase the risk of bleeding. In [[atrial fibrillation]], for instance, the risk of [[stroke]] (calculated on the basis of additional risk factors, such as advanced age, congestive heart failure, diabetes, [[hypertension|high blood pressure]]), and prior stroke, outweigh the risk of bleeding associated with [[warfarin]] use.<ref>{{NICE|36|Atrial fibrillation|June 2006}}</ref> | ||
In-hospital patients, thrombosis is a major cause for complications and is occasionally fatal. In 2005,a Parliamentary [[Health Select Committee]] in UK, stated that the annual rate of death due to hospital-acquired thrombosis was 25,000.<ref name=Hunt>{{cite journal |author=Hunt BJ |title=Awareness and politics of venous thromboembolism in the United kingdom |journal=Arterioscler. Thromb. Vasc. Biol. |volume=28 |issue=3 |pages=398–9 |year=2008 |month=March |pmid=18296598 |doi=10.1161/ATVBAHA.108.162586 |url=http://atvb.ahajournals.org/cgi/content/full/28/3/398}}</ref> | In-hospital patients, thrombosis is a major cause for complications and is occasionally fatal. In 2005,a Parliamentary [[Health Select Committee]] in UK, stated that the annual rate of death due to hospital-acquired thrombosis was 25,000.<ref name=Hunt>{{cite journal |author=Hunt BJ |title=Awareness and politics of venous thromboembolism in the United kingdom |journal=Arterioscler. Thromb. Vasc. Biol. |volume=28 |issue=3 |pages=398–9 |year=2008 |month=March |pmid=18296598 |doi=10.1161/ATVBAHA.108.162586 |url=http://atvb.ahajournals.org/cgi/content/full/28/3/398}}</ref> | ||
In patients admitted for surgery, [[compression stockings]] are widely used. In severe illness, prolonged immobility and in all [[orthopedic surgery]], [[clinical practice guideline|professional guidelines]] recommend | In patients admitted for surgery, [[compression stockings]] are widely used. In severe illness, prolonged immobility and in all [[orthopedic surgery]], [[clinical practice guideline|professional guidelines]] recommend: | ||
*[[ | *'''[[Low molecular weight heparin]] administration''': In patients with medical rather than surgical illness, LMWH is known to prevent thrombosis.<ref name=ACCP/><ref>{{cite journal |author=Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA |title=Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients |journal=Ann. Intern. Med. |volume=146 |issue=4 |pages=278–88 |year=2007 |month=February |pmid=17310052 |url=http://www.annals.org/cgi/reprint/146/4/278.pdf |format=PDF}}</ref> | ||
* | *'''Mechanical calf compression''': Sequential compression devices are commonly used in the inpatient setting. | ||
*[[Inferior vena cava filter| | *'''[[Inferior vena cava filter|Vena cava filter]]''' (if LMWH or mechanical compression is contraindicated and the patient has recently suffered [[deep vein thrombosis]]).<ref>{{NICE|46|Venous thromboembolism (surgical)|April 2007}}</ref><ref name=ACCP>{{cite journal |author=Geerts WH, Pineo GF, Heit JA, ''et al'' |title=Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy |journal=Chest |volume=126 |issue=3 Suppl |pages=338S–400S |year=2004 |month=September |pmid=15383478 |doi=10.1378/chest.126.3_suppl.338S |url=http://www.chestjournal.org/cgi/content/full/126/3_suppl/338S}}</ref> | ||
*'''Low-dose direct oral anticoagulants''': These include apixaban, rivaroxaban, and dabigatran. These medications do not require INR monitoring and are easier to administer than low molecular weight heparin or warfarin. The downside of direct oral anticoagulants is that it is more challenging to reverse bleeding associated with these agents. | |||
In United Kingdom, the [[Chief Medical Officer (United Kingdom)|Chief Medical Officer]] has issued guidelines that preventative measures should be used in patients, in anticipation of formal guidelines.<ref name=Hunt/> | In United Kingdom, the [[Chief Medical Officer (United Kingdom)|Chief Medical Officer]] has issued guidelines that preventative measures should be used in patients, in anticipation of formal guidelines.<ref name=Hunt/> | ||
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{{Circulatory system pathology}} | {{Circulatory system pathology}} | ||
[[Category:Hematology]] | [[Category:Hematology]] | ||
Latest revision as of 22:45, 30 December 2018
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Thrombosis prevention On the Web |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Prevention
Thrombosis and embolism can be partially prevented with anticoagulants in those deemed at risk. Generally, a risk-benefit analysis is required, as all anticoagulants increase the risk of bleeding. In atrial fibrillation, for instance, the risk of stroke (calculated on the basis of additional risk factors, such as advanced age, congestive heart failure, diabetes, high blood pressure), and prior stroke, outweigh the risk of bleeding associated with warfarin use.[1]
In-hospital patients, thrombosis is a major cause for complications and is occasionally fatal. In 2005,a Parliamentary Health Select Committee in UK, stated that the annual rate of death due to hospital-acquired thrombosis was 25,000.[2]
In patients admitted for surgery, compression stockings are widely used. In severe illness, prolonged immobility and in all orthopedic surgery, professional guidelines recommend:
- Low molecular weight heparin administration: In patients with medical rather than surgical illness, LMWH is known to prevent thrombosis.[3][4]
- Mechanical calf compression: Sequential compression devices are commonly used in the inpatient setting.
- Vena cava filter (if LMWH or mechanical compression is contraindicated and the patient has recently suffered deep vein thrombosis).[5][3]
- Low-dose direct oral anticoagulants: These include apixaban, rivaroxaban, and dabigatran. These medications do not require INR monitoring and are easier to administer than low molecular weight heparin or warfarin. The downside of direct oral anticoagulants is that it is more challenging to reverse bleeding associated with these agents.
In United Kingdom, the Chief Medical Officer has issued guidelines that preventative measures should be used in patients, in anticipation of formal guidelines.[2]
References
- ↑ National Institute for Health and Clinical Excellence. Clinical guideline 36: Atrial fibrillation. London, June 2006.
- ↑ 2.0 2.1 Hunt BJ (2008). "Awareness and politics of venous thromboembolism in the United kingdom". Arterioscler. Thromb. Vasc. Biol. 28 (3): 398–9. doi:10.1161/ATVBAHA.108.162586. PMID 18296598. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 Geerts WH, Pineo GF, Heit JA; et al. (2004). "Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy". Chest. 126 (3 Suppl): 338S–400S. doi:10.1378/chest.126.3_suppl.338S. PMID 15383478. Unknown parameter
|month=ignored (help) - ↑ Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA (2007). "Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients" (PDF). Ann. Intern. Med. 146 (4): 278–88. PMID 17310052. Unknown parameter
|month=ignored (help) - ↑ National Institute for Health and Clinical Excellence. Clinical guideline 46: Venous thromboembolism (surgical). London, April 2007.
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