Deep vein thrombosis prevention

Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2] ; Kashish Goel, M.D.; Assistant Editor(s)-In-Chief: Justine Cadet

Deep Vein Thrombosis Microchapters
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Patient Information
Overview
Classification
Pathophysiology
Causes
Differentiating Deep vein thrombosis from other Diseases
Epidemiology and Demographics
Risk Factors
Triggers
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Approach
Assessment of Clinical Probability and Risk Scores
Assessment of Probability of Subsequent VTE and Risk Scores
History and Symptoms
Physical Examination
Laboratory Findings
Ultrasound
Venography
CT
MRI
Other Imaging Findings
Treatment
Treatment Approach
Medical Therapy
IVC Filter
Invasive Therapy
Surgery
Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Special Scenario
Upper extremity DVT
Recurrence
Pregnancy
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Case #1
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Risk calculators and risk factors for Deep vein thrombosis prevention

Overview

Primary prevention includes the strategies that help to avoid the development of disease. Awareness of Deep venous thrombosis is the best way to prevent this condition.

Primary prevention

Walking is an effective preventative measure. It prevents backing up of blood in the lower limb vessels. Soleus is a powerful lower limb muscle which assist in walking. Also, in upright posture, it is responsible for pumping venous blood back into the heart from the periphery, and is often called the skeletal-muscle pump, peripheral heart or the sural (tricipital) pump.

Anticoagulants and mechanical measures may also be used. In 2012, the American College of Chest Physicians (ACCP) released their 9th edition of clinical guidelines, which included recommendations on VTE prevention. The recommendations were given strengths with "grades", depending upon the evidence for them.

Grade	Description of 2012 ACCP grade
1A	Strong recommendation, high-quality evidence
1B	Strong recommendation, moderate-quality evidence
1C	Strong recommendation, low- or very-low-quality evidence
2A	Weak recommendation, high-quality evidence
2B	Weak recommendation, moderate-quality evidence
2C	Weak recommendation, low- or very-low-quality evidence

Lifestyle modifications

The most common lifestyle risk factors for venous thromboembolism are:

1. Obesity,
2. Inactivity,
3. Cigarette smoking,
4. Avoid dehydration,
5. Maintain normal blood pressure.

Surgery patients

Surgery patients are at an increased risk of forming a DVT.

I) In patients who have undergone non-orthopedic surgery, depending upon the risk of VTE, risk of major bleeding, and patient preferences, following are potential recommended treatments.

• Early ambulation (walking).
• Mechanical prophylaxis (intermittent pneumatic compression [IPC] or graduated compression stockings [GCS]).
• Drugs (low-molecular-weight heparin [LMWH], low-dose-unfractionated heparin [LDUH])

II) In major orthopedic surgery patients—those undergoing total hip replacement, total knee replacement, and hip fracture surgery—additional drug options, such as fondaparinux and aspirin, are recommended (1B), though LMWH is preferred (2B or 2C). IPC is an option (1C).

Pregnancy

The risk of VTE is increased in pregnancy by about 4-fold due to a more hypercoaguable state, a likely adaptation against fatal postpartum hemorrhage.

Travelers

Main article: Economy class syndrome

There is clinical evidence that suggest, wearing compression socks, on long haul flights, reduces the incidence of thrombosis. 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 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..

Deep vein thrombosis guidelines for patients undergoing surgery

ACCP Guidelines - Recommendations for Prevention of VTE in Nonorthopedic Surgical Patients

General surgery, GI surgery, Urological surgery and Gynecologic surgery, Bariatric surgery, Vascular surgery, and Plastic and Reconstructive surgery

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1. For general and abdominal-pelvic surgery patients at very low risk for VTE ( < 0.5%; Rogers score, <7; Caprini score, 0), we recommend that no specific pharmaclogic (Grade 1B) or mechanical (Grade 2C) prophylaxis be used other than early ambulation. 2. For general and abdominal-pelvic surgery patients at low risk for VTE (~1.5%; Rogers score, 7-10; Caprini score, 1-2), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C) . 3. For general and abdominal-pelvic surgery patients at moderate risk for VTE (~3.0%; Rogers score, >10; Caprini score, 3-4) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B ), low-dose unfractionated heparin (LDUH) (Grade 2B) , or mechanical prophylaxis, preferably with IPC (Grade 2C) , over no prophylaxis. 4. For general and abdominal-pelvic surgery patients at moderate risk for VTE (3.0%; Rogers score, > 10; Caprini score, 3-4) who are at high risk for major bleeding complications or those in whom the consequences of bleeding are thought to be particularly severe, we suggest mechanical prophylaxis, preferably with IPC, over no prophylaxis (Grade 2C) . 5. For general and abdominal-pelvic surgery patients at high risk for VTE (~6.0%; Caprini score,≥5) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or LDUH (Grade 1B) over no prophylaxis. We suggest that mechanical prophylaxis with elastic stockings (ES) or IPC should be added to pharmacologic prophylaxis (Grade 2C). 6. For high-VTE-risk patients undergoing abdominal or pelvic surgery for cancer who are not otherwise at high risk for major bleeding complications, we recommend extended duration pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). 7. For high-VTE-risk general and abdominal-pelvic surgery patients who are at high risk for major bleeding complications or those in whom the consequences of bleeding are thought to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). 8. For general and abdominal-pelvic surgery patients at high risk for VTE (6%; Caprini score,≥5) in whom both LMWH and unfractionated heparin are contraindicated or unavailable and who are not at high risk for major bleed ing complications, we suggest low-dose aspirin (Grade 2C) , fondaparinux (Grade 2C) , or mechanical prophylaxis, preferably with IPC (Grade 2C) , over no prophylaxis. 9. For general and abdominal-pelvic surgery patients, we suggest that an inferior vena cava (IVC) filter should not be used for primary VTE prevention (Grade 2C). 10. For general and abdominal-pelvic surgery patients, we suggest that periodic surveillance with venous compression ultrasound (VCU) should not be performed (Grade 2C) .

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