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Venous Thromboembolism

Venous Thromboembolism. Reducing the Risk <Name of session> DATE. Objectives. Define venous thromboembolism Heighten awareness the impact of VTE the preventable nature of VTE Discuss importance of VTE risk assessment appropriate prescribing of prophylaxis engaging patients

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Venous Thromboembolism

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  1. Venous Thromboembolism Reducing the Risk <Name of session> DATE

  2. Objectives • Define venous thromboembolism • Heighten awareness • the impact of VTE • the preventable nature of VTE • Discuss importance of • VTE risk assessment • appropriate prescribing of prophylaxis • engaging patients • Demonstrate how to assess VTE risk

  3. Venous Thromboembolism • VTE = Deep vein thrombosis (DVT) and/or pulmonary embolism (PE)

  4. What Causes VTE • Virchow’s Triad = categories of factors contributing to blood clot formation Stasis Alteration in normal blood flow Hypercoagulability Alternation in the constitution of blood causing blood to clot more easily Endothelial Injury Injury or trauma to the inside of the blood vessel VIRCHOW’S TRIAD

  5. The Impact of VTE • More than 14,000 Australians develop a VTE per year • More than 5,000 of them will die as a direct result • VTE causes 7% of all hospital deaths VTE causes more deaths than bowel Ca and breast Ca

  6. VTE Risk Factors

  7. VTE Risk Factors

  8. Hospitalisation • Hospitalisation = ↑ risk of VTE • ~ 50% of VTE cases occur during or soon after hospitalisation • 24% (surgery) • 22% (medical illness) • Incidence 100 times greater in hospitalised patients than community residents

  9. Preventing VTE

  10. Preventability • Largely preventable • Shift thinking: complication vs adverse event

  11. Assessing Risk • Who should be assessed?

  12. Assessing Risk • Assess overall VTE risk vs benefit • Assess clotting risk • Assess bleeding risk i.e. contraindications to prophylaxis and/or other bleeding risks • <indicate what tool is available at your facility (State Tool* or Local Tool)>

  13. Prescribing Prophylaxis • Patient at risk + nil C/I = prescribe • Two types of prophylaxis: 1. pharmacological 2. mechanical • Ensure C/I to both pharmacological and mechanical prophylaxis have been considered • Evidence-based guidelines

  14. NHMRC Guidelines

  15. Pharmacological Prophylaxis • Anticoagulants • Alter the process of blood coagulation to prevent VTE formation The coagulation cascade and activity of anticoagulants http://www.healio.com/orthopedics/hip/news/online/%7Ba0ebf835-ae3d-42df-a9e5-ae55b11e0413%7D/new-oral-anticoagulants-for-thromboprophylaxis-after-total-hip-or-knee-arthroplasty

  16. Pharmacological Prophylaxis • Main anticoagulants include:

  17. Pharmacological Prophylaxis • Contraindications may include: • Other relative contraindications may exist – weigh risk vs benefit

  18. Mechanical Prophylaxis • Devices that increase blood flow velocity in leg veins, reducing venous stasis. • They include:

  19. Mechanical Prophylaxis • Contraindications may include:

  20. Other Ways to Help Prevent VTE

  21. Empowering Patients • Engage your patients

  22. Questions For further information: stopclots@cec.health.nsw.gov.au www.cec.health.nsw.gov.au

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