Thursday, November 29, 2012

Preventing Venous Thromboembolism (VTE) in Hospitals
To prevent clots or to bleed, that is the question.
November 29, 2012 - Today’s subject is how hospitals can prevent venous thromboembolism VTE), a leading cause of hospital deaths. Physicians may be indirectly responsible for some of these deaths because the underestimate the danger of clotting and overestimate the risk of bleeding through use of heparin or other anticoagulants.
According to Greg Maynard, MD, of the Division of Hospital Medicine at the University of California. VTE is perhaps the single greatest cause of morbidity and mortality in U.S. hospitals.
· accounts for 350,000 to 650,000 hospital cases each year

· causes 100,000 to more than 250,000 deaths

· occurs mostly in hospitals

· leads to 10% of hospital deaths

· accounts for many hospital readmissions.

VTE risk factors are present in as least one of every two hospital patients.

The risk factors are:
- any over age 40

- immobility

- congestive heart failure

- stroke

- paralysis

- spinal cord injury

- polychythemia

- severe COPD

- anesthesia

- obesity varicose vein
-high estrogen states
-inflammatory bowel disease
- nepthrotic syndrome
- thrombophlebitis

Endothelial damage


-prior VTE

- central vein line

- trauma

Since these conditions are so common, it makes sense to have set orders for anti-embolic stocking and intermittent pneumatic compression for most bed-ridden patients and anticoagulants for those are high risk. Those at high risk include patients undergoing hip or knee replacements and those with deep venous thrombosis.

How to institute and implement these preventive steps is easier said than done. No comprehensive prophylactic model exists. A number of solutions have been suggested.

- An electronic alert system based on risk factors in chart.

- Team education

- Standardized orders

- Periodic audits to alert physicians and staff to complications
There is no perfect preventive system, but most systems that have been introduced have led to a 40% to 45% reduction in thromboembolic episodes and deaths.

Tweet:  Venous thromboembolic (VTE) cause 10% of hospital deaths.  As many as 40% to 45% ov VTE events can be prevented through systematic preventive measures.

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