Physician practices in the prevention of venous thromboembolism

Article Abstract:

Venous thromboembolism is the formation of blood clots in the circulation, often of the legs. The blood clots in the legs have a tendency to break away and travel throughout the bloodstream until they reach a vessel too small to pass through; they lodge in this vessel, obstructing blood flow and causing damage. Clots from the legs most often lodge in the lungs as pulmonary emboli, which can be fatal. The incidence of pulmonary embolism is greatly underestimated by physicians, and some studies suggest that as many as two-thirds of them are undiagnosed. Certain people are at higher risk for the development of venous thromboemboli than others. These include the elderly, those who have had major surgery, those who are bedridden for longer than five days, people with cancer or heart disease, and people who are obese or pregnant. Recent studies have suggested that the use of blood-thinning medications and devices to promote good circulation are very useful in reducing the incidence of thromboembolism in people at risk. A study was performed in 16 hospitals to determine the rate at which such prophylactic measures against thromboembolism are used. A randomly selected group of over 2,000 patients deemed to be at high risk for thromboemboli were assessed. Of these, 563 received acceptable thromboembolism prophylaxis. Teaching hospitals had a 44 percent prophylaxis rate, while community hospitals had only a 19 percent prophylaxis rate. Surgeons were more likely to order prophylaxis than nonsurgeons. Patients with a history of previous pulmonary embolism were likely to receive prophylaxis, while those with a history of only venous thrombosis were less likely to receive prophylactic measures, despite the known risk of recurrent venous thrombosis. Of note, this study was completed before the more recent studies showing the value of prophylaxis were published, so some possibility exists that the practice of treating a patient for a risk of thromboembolism has increased. However, several studies have suggested that changes in practice do not follow the publication of new data very rapidly. To reduce the mortality associated with thromboembolic disease, patients with high risk should be evaluated for their need for prophylactic therapies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Risk factors

---

A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism: the Worcester DVT study

Article Abstract:

To learn more about the incidence and outcome of deep vein thrombosis (DVT, a blood clot in a deep-lying vein, often in the leg) and pulmonary embolism (blockage of the circulation in the lungs by a clot that has migrated there), the medical records of patients discharged during an 18-month period from 16 short-stay general hospitals in one region of Massachusetts were reviewed. Of 151,349 acute-care discharges, slightly fewer than 1 percent (1,372) had the diagnosis of acute DVT and/or pulmonary embolism. This episode of DVT was the first for 405 patients in the group. Three or more risk factors for venous thromboembolism were present in 80 percent of these patients; many also had clinical signs of the condition. The data indicate that the annual incidence of DVT alone is 48 per 100,000, and the incidence of pulmonary embolism with or without DVT is 23 per 100,000. Twelve percent of the patients with venous thromboembolism died in the hospital; older patients were more likely than younger ones to die during their hospital stays. Nineteen percent, 25 percent, and 30 percent, respectively, of the patients had died one, two and three years after discharge. Extrapolation of these results to the US population indicates that approximately 170,000 new cases of venous thromboembolism are treated every year in short-stay hospitals, as well as an additional 99,000 recurrent cases. Diagnosis of venous thromboembolism is difficult, and fewer than half of all cases of pulmonary embolism are identified before death. It is likely that the true incidence of thromboembolism is underestimated. A more aggressive approach to preventing and treating these disorders could reduce the associated mortality. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cases, Statistics, Thrombosis, Deep vein, Deep vein thrombosis

---

Prophylaxis against venous thromboembolism in surgical patients

Article Abstract:

A common complication of major surgery is the development of venous thromboembolism, blockage of a vein by a clot which may break free and travel within the circulatory system; this is a serious complication and occasionally is fatal. Although this condition can be prevented, studies in the United States have shown that many surgical patients at risk for thromboembolism do not receive effective prophylaxis (preventive treatment). A strong deterrent to using anticoagulation as prophylaxis is concern over the possibility of hemorrhage. Patients who do not receive prophylaxis have been shown to have a high incidence of deep venous thrombosis. After major abdominal surgery, the incidence of fatal pulmonary embolism (when the blood clot reaches the lung) is reported to be between 0.5 and 1 percent; after total hip replacement the incidence is between 2 and 6 percent. Prophylaxis techniques may be physical, with the use of elastic stockings or intermittent calf compression, or chemical using low-dose heparin, anticoagulants, and aspirin. A review of medical records from 16 hospitals was undertaken; this revealed that prophylaxis was given to only 32 percent of all high-risk patients (patients older than 40, in the hospital more than five days, and with one or more additional risk factors). Prophylactic therapy rates were lowest in nonteaching hospitals (19 percent compared with 44 percent at teaching institutions). New prophylactic methods, such as the promising low-molecular-weight heparin, may increase effectiveness, encourage wider use and reduce complications. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Complications and side effects, Surgery, Postoperative complications, Fibrinolytic agents, Thrombolytic drugs

Similar abstracts:

• Abstracts: Efficacy and safety of nafarelin in the treatment of endometriosis. Nafarelin in the treatment of pelvic pain caused by endometriosis
• Abstracts: Heparin for 5 days as compared with 10 days in the initial treatment of proximal venous thrombosis. Effectiveness of intermittent pneumatic leg compression for preventing deep vein thrombosis after total hip replacement
• Abstracts: Heparin for 5 days as compared with 10 days in the initial treatment of proximal venous thrombosis. part 2 Establishing a therapeutic range for heparin therapy
• Abstracts: The association of intrapartum asphyxia in the mature fetus with newborn behavior. Severe fetal asphyxia associated with neuropathology
• Abstracts: Grand Cru versus generic: different approaches to altering the ratio of general internists to subspecialists. Subspecialists and internal medicine: a perspective

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.