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| [[Clinical practice guidelines]] by the American College of Chest Physicians (ACCP) provide recommendations on DVT prophylaxis in hospitalized patients <ref name="pmid15383478">Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. | | [[Clinical practice guidelines]] by the American College of Chest Physicians (ACCP) provide recommendations on DVT prophylaxis in hospitalized patients <ref name="pmid15383478">Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. |
| Chest. 2004 Sep;126 (3 Suppl):338S-400S. http://www.chestjournal.org/cgi/content/full/126/3_suppl/338S PMID 15383478</ref>. | | Chest. 2004 Sep;126 (3 Suppl):338S-400S. http://www.chestjournal.org/cgi/content/full/126/3_suppl/338S PMID 15383478</ref>. |
| ===General Medical Inpatients===
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| Regarding general medical inpatients the guidelines state, "In acutely ill medical patients who have been admitted to the hospital with congestive heart failure or severe respiratory disease, or who are confined to bed and have one or more additional risk factors, including active cancer, previous VTE, [[sepsis]], acute neurologic disease, or inflammatory bowel disease, we recommend prophylaxis with LDUH (Grade 1A) or LMWH (Grade 1A)<ref name="pmid15383478">.</ref>." Enoxaparin or unfractionated heparin may be used.<ref>{{cite journal|title=Twice vs three times daily heparin dosing for thromboembolism prophylaxis in the general medical population: A metaanalysis|author=King CS, Holley AB, Jackson JL, Shorr AF, Moores LK|journal=Chest|year=2007|volume=131|issue=2|pages=507–16|pmid=17296655}}</ref> LMWH may be more effective than UFH. If UFH heparin is used, 5000 U 3 times daily may be more effective.<ref name="pmid17646601">{{cite journal |author=Wein L, Wein S, Haas SJ, Shaw J, Krum H |title=Pharmacological Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients: A Meta-analysis of Randomized Controlled Trials |journal= |volume=167 |issue=14 |pages=1476-1486 |year=2007 |pmid=17646601 |doi=10.1001/archinte.167.14.1476}}</ref>
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| Since publication of the ACCP guidelines, an additional [[randomized controlled trial]] <ref name="pmid16431185">Lederle FA, Sacks JM, Fiore L, Landefeld CS, Steinberg N, Peters RW, Eid AA, Sebastian J, Stasek JE Jr, Fye CL. The prophylaxis of medical patients for thromboembolism pilot study. Am J Med. 2006;119:54-9. PMID 16431185</ref> and [[meta-analysis]] <ref name="pmid17310052">Dentali F, Douketis JD, Gianni M, Lim W, Crowther MA. [http://annals.org/cgi/content/full/146/4/278 Meta-analysis: anticoagulant prophylaxis to prevent symptomatic venous thromboembolism in hospitalized medical patients]. Ann Intern Med. 2007;146:278-88. PMID 17310052</ref> including the trial have been published. The [[meta-analysis]] concluded " Anticoagulant prophylaxis is effective in preventing symptomatic venous thromboembolism during anticoagulant prophylaxis in at-risk hospitalized medical patients. Additional research is needed to determine the risk for venous thromboembolism in these patients after prophylaxis has been stopped." With regards to which patients are at risk, most studies in the meta-analysis were of patients with [[New York Heart Association Functional Classification]] (NYHA) III-IV heart failure. Regarding patients at lesser risk of DVT, the trial above<ref name="pmid16431185">.</ref> and an earlier trial<ref name="pmid">Gardlund B. Randomised, controlled trial of low-dose heparin for prevention of fatal pulmonary embolism in patients with infectious diseases. The Heparin Prophylaxis Study Group. Lancet. 1996 May 18;347(9012):1357-61. PMID 8637340</ref> are relevant yet inconclusive.
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| Chronic renal dialysis patients may be at increased risk of thromboembolism<ref name="pmid11979344">{{cite journal |author=Tveit DP, Hypolite IO, Hshieh P, ''et al'' |title=Chronic dialysis patients have high risk for pulmonary embolism |journal=Am. J. Kidney Dis. |volume=39 |issue=5 |pages=1011-7 |year=2002 |pmid=11979344 |doi=}}</ref>, but [[randomized controlled trial]]s have not addressed the risk benefit of prophylaxis.
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| ===Surgery Patients===
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| In patients who have undergone [[surgery]], [[low molecular weight heparin]]s (LMWH) are routinely administered to prevent thrombosis. LMWH can only currently be administered subcutaneously by injection. Prophylaxis for pregnant women who have a history of thrombosis may be limited to LMWH injections or may not be necessary if their risk factors are mainly temporary.
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| Early and regular ambulation (walking) is a treatment that predates anticoagulants and is still recognized and used today. Walking activates the body's muscle pumps, increasing venous velocity and preventing [[stasis]]. Intermittent pneumatic compression (IPC) machines have proven protective in bed- or chair-ridden patients at very high risk or with contraindications to heparins. IPC machines use air bladders that are wrapped around the thigh and/or calf. The bladders alternately inflate and deflate, squeezing the muscles and increasing blood velocity by as much as 500%. IPC machines have been proven effective on knee and hip surgery patients (a population with a risk as high as 80% with no prophylactic treatment) of developing DVT and PE.
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| Alternatively, between 150-300mg of aspirin can be taken.
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| In knee replacement patients, the timing of perioperative LMWH was recorded as the main risk factor of postoperative knee prosthesis infection.<ref name="pmid21053884">{{cite journal| author=Asensio A, Antolín FJ, Sanchez-García JM, Hidalgo O, Hernández-Navarrete MJ, Bishopberger C et al.| title=Timing of DVT prophylaxis and risk of postoperative knee prosthesis infection. | journal=Orthopedics | year= 2010 | volume= 33 | issue= 11 | pages= 800 | pmid=21053884 | doi=10.3928/01477447-20100924-12 | pmc= | url= }} </ref>
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| ===Travelers=== | | ===Travelers=== |
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]
Overview
Primary prevention as the name suggest strategies intend to avoid the development of disease.
Lifestyle modifications
The most common lifestyle risk factors for venous thromboembolism are:
- Obesity,
- Inactivity,
- Cigarette smoking,
- Avoid dehydration,
- Maintain normal blood pressure.
Prophylaxis (Prevention)
Clinical practice guidelines by the American College of Chest Physicians (ACCP) provide recommendations on DVT prophylaxis in hospitalized patients [1].
Travelers
There is clinical evidence to suggest that wearing compression socks while travelling also reduces the incidence of thrombosis in people on long haul flights. A randomised study in 2001 compared two sets of long haul airline passengers, one set wore travel compression hosiery the others did not. The passengers were all scanned and blood tested to check for the incidence of DVT. The results showed that asymptomatic DVT occurred in 10% of the passengers who did not wear compression socks. The group wearing compression had no DVTs. The authors concluded that wearing elastic compression hosiery reduces the incidence of DVT in long haul airline passengers. J Scurr et al. 2001 Lancet.[2].
References
- ↑ Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, Ray JG. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
Chest. 2004 Sep;126 (3 Suppl):338S-400S. http://www.chestjournal.org/cgi/content/full/126/3_suppl/338S PMID 15383478
- ↑ Scurr JH, Machin SJ, Bailey-King S, Mackie IJ, McDonald S, Smith PD. Frequency and prevention of symptomless deep-vein thrombosis in long-haul flights: a randomised trial. Lancet 2001;12(9267):1485-9. PMID 11377600.
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