4070F Deep vein thrombosis (DVT) prophylaxis received by end of hospital day 2 (STR)

Name of the Procedure:

Deep Vein Thrombosis (DVT) Prophylaxis, Thromboprophylaxis

Summary

Deep vein thrombosis (DVT) prophylaxis involves preventive measures to reduce the risk of blood clots forming in the deep veins, typically in the legs. These measures are crucial for hospitalized patients who may be immobile for extended periods.

Purpose

DVT prophylaxis aims to prevent the formation of blood clots which can cause serious complications such as pulmonary embolism (a life-threatening condition where a clot travels to the lungs). The goals are to minimize the risk of clot formation and ensure safe recovery, especially in high-risk hospitalized patients.

Indications

DVT prophylaxis is indicated for patients who:

• Are hospitalized for surgery, particularly orthopedic or major surgical procedures.
• Are immobile or confined to bed for extended periods.
• Have a history of DVT or pulmonary embolism.
• Have medical conditions that increase the risk of blood clotting (e.g., cancer, heart failure, or severe infections).

Preparation

• Patients may be advised to wear compression stockings.
• Certain medications like anticoagulants (e.g., heparin or enoxaparin) might be prescribed.
• Pre-procedure assessments may include blood tests to evaluate coagulation status.

Procedure Description

1. Medication: Administration of anticoagulants via subcutaneous injection or oral route to thin the blood and reduce clot formation.
2. Mechanical Devices: Use of compression stockings or intermittent pneumatic compression devices to enhance blood flow in the legs.
3. Early Mobilization: Encouraging patients to move and walk as soon as medically feasible.
4. Hydration: Ensuring adequate fluid intake to maintain proper blood viscosity.

Duration

The duration of DVT prophylaxis depends on the patient’s risk factors and mobility but usually continues until the patient is back to normal activity levels or discharged from the hospital.

Setting

DVT prophylaxis is typically performed in a hospital setting but may continue at home or in an outpatient clinic depending on the patient's condition.

Personnel

Involves a multidisciplinary team including:

• Doctors (e.g., hospitalists, surgeons)
• Nurses
• Pharmacists
• Physical therapists

Risks and Complications

• Bleeding due to anticoagulant use.
• Allergic reactions to medications.
• Skin irritation from compression devices.

Benefits

• Reduces the risk of DVT and associated complications such as pulmonary embolism.
• Promotes safer recovery and quicker mobilization for patients.
• Benefits are usually realized within days to weeks following consistent prophylactic measures.

Recovery

• Follow prescribed medication plans and wear compression devices as advised.
• Regularly scheduled follow-up appointments to monitor coagulation parameters and adjust treatments if necessary.
• Most patients can return to normal activity levels, contingent on the underlying reason for hospitalization and overall health status.

Alternatives

• Use of alternative anticoagulants with different risk profiles.
• Mechanical prevention methods alone, particularly for patients with high risk of bleeding.
• Lifestyle modifications and long-term interventions for patients with recurring concerns.

Patient Experience

Patients may experience minor discomfort from injections or wearing compression stockings/devices. Pain management and comfort measures include:

• Proper sizing and fitting of compression stockings to prevent irritation.
• Regularly scheduled administration times for anticoagulants to ensure consistency and avoid missed doses.
• Education on signs of excessive bleeding or complications.