Prevention of Venous Thromboembolism
|
|
- Madeleine Heath
- 6 years ago
- Views:
Transcription
1 Prevention of Venous Thromboembolism Surgical Care Improvement Project Dale W. Bratzler, DO, MPH President and CEO Dale W. Bratzler, DO, MPH Oklahoma Foundation for Medical Quality QIOSC Medical Director Why is there a need to measure the quality of hospital care? The passive strategy of guideline publication and dissemination does not effectively change clinical practice The time lag between publication of evidence and incorporation into care at the bedside is very long Variations in care and delivery of care that is not consistent with evidence-based recommendations is well documented Bratzler DW. Development of national performance measures on the prevention and treatment of venous thromboembolism. J Thromb Thrombolysis (in press) 1
2 Prevention of Venous Thromboembolism (VTE) an example The American College of Chest Physicians published their first consensus conference on antithrombotic therapy in 1986 In 2008 published their 8 th edition of the evidence-based guideline Despite all of these published editions.. VTE - the most common preventable cause of hospital death - 2/3 of all cases occur in recently hospitalized patients - up to 3/4 of all cases of PE death are a result of hospitalization Prevention of Venous Thromboembolism an example Multiple studies that have included hospital medical record audits show consistent underuse of VTE prophylaxis Up to 2/3 of patients with hospital-acquired VTE did not receive prophylaxis Audits of patients receiving treatment for confirmed VTE show non-compliance with guideline-recommended treatment Bratzler DW. Development of national performance measures on the prevention and treatment of venous thromboembolism. J Thromb Thrombolysis (in press) 2
3 The best estimates indicate that 350,000 to 600,000 Americans each year suffer from DVT and PE, and that at least 100,000 deaths may be directly or indirectly related to these diseases. This is far too many, since many of these deaths can be avoided. Because the disease disproportionately affects older Americans, we can expect more suffering and more deaths in the future as our population ages unless we do something about it. Risk Factors for DVT or PE Nested Case-Control Study (n=625 case-control pairs) Surgery Trauma Inpatient Malignancy with chemotherapy Malignancy without chemotherapy Central venous catheter or pacemaker Neurologic disease Superficial vein thrombosis Varicose veins/age 45 yr Varicose veins/age 60 yr Varicose veins/age 70 yr CHF, VTE incidental on autopsy CHF, antemortem VTE/causal for death Liver disease Odds ratio 3
4 Outpatients With VTE, % Risk Factors for VTE Most hospitalized patients have at least one additional risk factor for VTE Surgery Trauma Immobility, paresis Malignancy Cancer therapy hormonal therapy, chemotherapy or radiotherapy Previous VTE Increasing age Pregnancy and post-partum period Estrogen-containing oral contraception or HRT or SERM Acute medical illness Heart failure Respiratory failure Inflammatory bowel disease Nephrotic syndrome Myeloproliferative disorders Obesity Smoking Varicose veins Central venous catheterization Inherited or acquired thrombophilia Travel Geerts W et al. Chest. 2004;126:338S-400S. VTE Facts Almost half of the outpatients with VTE had been recently hospitalized Less than half of the recently hospitalized patients had received VTE prophylaxis during their hospitalizations About half had a length of stay (LOS) of < 4 days Days After Discharge Medical Hospitalization Only Hospitalization with Surgery Goldhaber S. Arch Intern Med. 2007;167: Spencer FA et al. Arch Intern Med. 2007;167(14):
5 Categories of Risk for Venous Thromboembolism in Patients Low risk: Minor surgery in mobile patients Moderate risk: Most medically ill, general, open gyn or urologic surgery patients High risk: Cancer surgery, hip or knee arthroplasty, hip fracture surgery, major trauma or spinal cord injury Geerts W et al. Chest. 2008;133:381S-453S. Mechanical Methods of VTE Prevention Graduated Compression Stockings (GCS) Intermittent Pneumatic Compression Devices (IPCs) Venous Foot Pump (VFP) 5
6 Patients with PE (%) Pharmacologic Options for VTE Prevention Unfractionated Heparin (UFH) Low-Molecular Weight Heparins (LMWHs) Pentasaccharide (Fondaparinux) Warfarin Prophylaxis Against Fatal Post-Operative PE With LDUH: A Multicenter, Prospective, Randomized Trial Study population: 4,121 patients age > 40 y undergoing a variety of elective major surgical procedures P < Control (N = 2,076) UFH* (N = 2,045) 5,000 IU SC 2 hours preoperatively and 8 hours thereafter for 7 days. Kakkar VV et al. Lancet. 1975;2:
7 Mechanical Thromboprophylaxis For particularly high-risk surgery patients with multiple risk factors, pharmacologic method should be combined with mechanical method (GCS, IPC) (1C) Use mechanical methods for patients with high bleeding risk (1A), when bleeding risk decreases substitute or add pharmacological thromboprophylaxis (1C) Geerts WH et al. Chest. 2008;133(6 Suppl):381S-453S. Problems with Mechanical Prophylaxis Non-compliance ~ 50% of med-surg floors ~80% in intensive care units Most common reasons for non-compliance ~80% of the time, not on the patient ~20% of the time, on the patient but not turned on 7
8 VTE Prophylaxis Grade 1 Recommendations Surgery* General surgery General surgery with a reason for not administering pharmacologic prophylaxis documented Gynecologic surgery Recommended Prophylaxis Low-dose unfractionated heparin (LDUH) Low molecular weight heparin (LMWH) Fondaparinux (effective 10/01/07) LDUH or LMWH combined with IPC or GCS Graduated Compression stockings (GCS) Intermittent pneumatic compression (IPC) Low-dose unfractionated heparin (LDUH) Low molecular weight heparin (LMWH) Factor Xa inhibitor Intermittent pneumatic compression devices (IPC) LDUH, LMWH, or factor Xa inhibitor combined with IPC or GCS *Limited to those patients who have an anesthesia duration of at least 60 minutes, and a hospital stay of at least three calendar days (two nights in the hospital). *Open surgical procedure > 30 minutes requiring in-hospital stay > 24 hours postoperative. VTE Prophylaxis Grade 1 Recommendations Surgery Urologic surgery Elective total hip replacement Elective total knee replacement Recommended Prophylaxis Low-dose unfractionated heparin (LDUH) 5000 units bid or tid Low molecular weight heparin (LMWH) Factor Xa inhibitor (fondaparinux) Intermittent pneumatic compression devices (IPC) Graduated compression stockings (GCS) LDUH, LMWH, or factor Xa inhibitor combined with IPC or GCS Low molecular weight heparin (LMWH) Factor Xa inhibitor (fondaparinux) Adjusted-dose warfarin (INR target 2.5, range ) Low molecular weight heparin (LMWH) Factor Xa inhibitor (fondaparinux) Adjusted-dose warfarin (INR target 2.5, range ) Intermittent pneumatic compression devices (IPC) Venous foot pumps (VFP) 8
9 VTE Prophylaxis Grade 1 Recommendations Surgery Hip fracture surgery Hip fracture surgery (HFS) or elective total hip replacement with a reason for not administering pharmacologic prophylaxis documented Intracranial neurosurgery Recommended Prophylaxis Low molecular weight heparin (LMWH) Factor Xa inhibitor Adjusted-dose warfarin (INR target 2.5, range ) Low-dose unfractionated heparin (LDUH) Graduated Compression stockings (GCS) (HFS only) Intermittent pneumatic compression (IPC) Venous foot pumps (VFP) IPC with or without GCS Low-dose unfractionated heparin (LDUH) Postoperative Low molecular weight heparin (LMWH) LDUH or LMWH combined with IPC or GCS *Open surgical procedure > 30 minutes requiring in-hospital stay > 24 hours postoperative. Performance Measurement Does Not Happen without Controversy 9
10 Summary American Academy of Orthopedic Surgeons (AAOS) Clinical Guideline on Prevention of Symptomatic Pulmonary Embolism in Patients Undergoing Total Hip or Knee Arthroplasty Standard risk PE, Standard risk Bleeding* aspirin LMWH synthetic pentasaccharides warfarin Level III, Grade B recommendation Standard risk PE, Elevated risk Bleeding aspirin warfarin none Level III, Grade C recommendation Elevated risk PE, Standard risk Bleeding LMWH synthetic pentasaccharides warfarin Level III, Grade B recommendation Elevated risk PE, Elevated risk Bleeding aspirin warfarin none Level III, Grade C recommendation SCIP VTE 1 Performance Measure Hip or Knee Arthroplasty No Bleeding Risk Documented Hip or knee arthroplasty: LMWH synthetic pentasaccharides warfarin Documented Bleeding Risk Mechanical Prophylaxis [any other modality (including aspirin or warfarin) can be added] Knee arthroplasty only: intermittent pneumatic compression devices venous foot pump What else does the AAOS guideline say? They do NOT recommend the use of aspirin alone They recommend the use of mechanical prophylaxis started in the operating room or immediately postoperatively in all patients continued to discharge They recommend pharmacologic prophylaxis with LMWH, factor Xa inhibitor, or warfarin in high risk patients previous history of cancer, thromboembolism, hypercoagulable states such as polycythemia, spinal cord injury patients, multi-trauma patients, and genetic predisposition 10
11 VTE Prophylaxis Other issues Timing of prophylaxis Neuraxial anesthesia Renal insufficiency Duration of prophylaxis 11
12 Venous Thromboembolism Statement of Organization Policy Every healthcare facility shall have a written policy appropriate for its scope, that is evidence-based and that drives continuous quality improvement related to VTE risk assessment, prophylaxis, diagnosis, and treatment. Measure specifications available at: 12
13 Electronic Submission of Performance Measures In the recently published final IPPS rule for fiscal year 2010, CMS has announced that through an interagency agreement with the Office of the National Coordinator for Healthcare Information Technology, they are developing interoperable standards for electronic medical record submission of the newly-endorsed VTE measures. Vendors of electronic medical record systems would be able to code their systems with the new specifications by the end of Centers for Medicare & Medicaid Services. Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates; and Changes to the Long-Term Care Hospital Prospective Payment System and Rate Years 2010 and 2009 Rates. Available at: Accessed 10 August Improving Use of VTE Prophylaxis 13
14 Strategies to Improve VTE Prophylaxis Hospital policy of risk assessment or routine prophylaxis for all admitted patients Most will have risk factors for VTE and should receive prophylaxis Preprinted protocols for surgical patients Electronic Alerts to Prevent VTE among Hospitalized Patients Hospital computer system identified patient VTE risk factors RCT: no physician alert vs physician alert Control Alert group group P No. 1,251 1,255 Any prophylaxis 15 % 34 % <0.001 VTE at 90 days 8.2 % * 4.9 % Major bleeding 1.5 % 1.5 % NS * NNT = 30 Kucher NEJM 2005;352:969 14
15 Improving Compliance with Treatment Protocols Use of standardized protocols, nomograms, algorithms, or preprinted orders Address overlap (either 5 days in hospital or discharge on overlap) When used, UFH should be managed by nomogram/protocol, and the protocol should ensure routine platelet count monitoring Essential Elements for Improvement Institutional support A multidisciplinary team or steering committee Reliable data collection and performance tracking Specific goals or aims A proven QI framework Protocols SHM Resource Room. Accessed September
16 Low Risk Assessment Prophylaxis Ambulatory patient without VTE risk factors; observation patient with expected LOS 2 days; same day surgery or minor surgery Early ambulation Moderate High All other patients (not in low-risk or high-risk category); most medical/surgical patients; respiratory insufficiency, heart failure, acute infectious, or inflammatory disease Lower extremity arthroplasty; hip, pelvic, or severe lower extremity fractures; acute SCI with paresis; multiple major trauma; abdominal or pelvic surgery for cancer UFH 5000 units SC q 8 hours; OR LMWH q day; OR UFH 5000 units SC q 12 hours (if weight < 50 kg or age > 75 years); AND suggest adding IPC LMWH (UFH if ESRD); OR fondaparinux 2.5 mg SC daily; OR warfarin, INR 2-3; AND IPC (unless not feasible) Maynard GA, et al. J Hosp Med 2009 Sep 14. [Epub ahead of print] Maynard GA, et al. J Hosp Med 2009 Sep 14. [Epub ahead of print] 16
17 Maynard GA, et al. J Hosp Med 2009 Sep 14. [Epub ahead of print] Maynard GA, et al. J Hosp Med 2009 Sep 14. [Epub ahead of print] 17
18 Attention to Transitions of Care Ensure adequate training of the patient Education on medications, diet, follow up appointments, lab monitoring, dietary precautions, and adverse reactions or drugdrug interactions Education for family Referral to anticoagulation clinic Hospital abstractors must find explicit documentation of this training/education in the chart Does public reporting accelerate quality improvement? 18
19 Percent Changes in National Performance Baseline to Q1, 2009 Recommended VTE prophylaxis VTE prophylaxis received Q1, 2005* // Q Q Q Q Q Q Q Q Q Q Q Q *National sample of 19,497 Medicare patients undergoing surgery in US hospitals during the first quarter of (Bratzler, unpublished data Hospital-acquired Conditions Background of the Never Events Deficit Reduction Act (DRA) of 2005 requires the Secretary of HHS to identify conditions that are: High cost or high volume (or both); and Result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis; and Could reasonably have been prevented through the application of evidence-based guidelines. 19
20 Hospital-acquired Conditions 10. Deep vein thrombosis/pulmonary embolism following Total knee replacement Hip replacement Conclusions VTE remains a substantial health problem in the US VTE prophylaxis remains underutilized National performance measures will address both prophylaxis and treatment of VTE across broad hospital populations 20
21 21
Objectives. Venous Thromboembolism (VTE) Prophylaxis. Case VTE WHY DO IT? Question: Who Is At Risk?
Objectives Venous Thromboembolism (VTE) Prophylaxis Rishi Garg, MD Department of Medicine Identify patients at risk for VTE Options for VTE prophylaxis Current Recommendations (based on The Seventh ACCP
More informationCMS National Patient Safety Initiative for Surgical Care
CMS National Patient Safety Initiative for Surgical Care Ongoing Opportunities for Improvement Dale W. Bratzler, DO, MPH President and CEO Oklahoma Foundation for Medical Quality An update where are we
More informationVenous Thromboembolism Prophylaxis
Approved by: Venous Thromboembolism Prophylaxis Vice President and Chief Medical Officer; and Vice President and Chief Operating Officer Corporate Policy & Procedures Manual Number: Date Approved January
More informationMisunderstandings of Venous thromboembolism prophylaxis
Misunderstandings of Venous thromboembolism prophylaxis Veerendra Chadachan Senior Consultant Dept of General Medicine (Vascular Medicine and Hypertension) Tan Tock Seng Hospital, Singapore Case scenario
More informationAnticoagulation for prevention of venous thromboembolism
Anticoagulation for prevention of venous thromboembolism Original article by: Michael Tam Note: updated in June 2009 with the eighth edition (from the seventh) evidence-based clinical practice guidelines
More informationVenous Thromboembolism. Prevention
Venous Thromboembolism Prevention August 2010 Venous Thromboembloism Prevention 1 1 Expected Practice Assess all patients upon admission to the ICU for risk factors of venous thromboembolism (VTE) and
More informationEarly Ambulation Reduces the Risk of Venous Thromboembolism After Total Knee Replacement. Marilyn Szekendi, PhD, RN
Early Ambulation Reduces the Risk of Venous Thromboembolism After Total Knee Replacement Marilyn Szekendi, PhD, RN ANA 7 th Annual Nursing Quality Conference, February 2013 Research Team Banafsheh Sadeghi,
More informationNOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section.
TITLE VENOUS THROMBOEMBOLISM PROPHYLAXIS SCOPE Provincial Acute and Sub-Acute Care Facilities APPROVAL AUTHORITY Alberta Health Services Executive Committee SPONSOR Vice President, Quality and Chief Medical
More informationINDICATIONS FOR THROMBO-PROPHYLAXIS AND WHEN TO STOP ANTICOAGULATION BEFORE ELECTIVE SURGERY
INDICATIONS FOR THROMBO-PROPHYLAXIS AND WHEN TO STOP ANTICOAGULATION BEFORE ELECTIVE SURGERY N.E. Pearce INTRODUCTION Preventable death Cause of morbidity and mortality Risk factors Pulmonary embolism
More informationDVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients. David Liff MD Oklahoma Heart Institute Vascular Center
DVT Pathophysiology and Prophylaxis in Medically Hospitalized Patients David Liff MD Oklahoma Heart Institute Vascular Center Overview Pathophysiology of DVT Epidemiology and risk factors for DVT in the
More informationVenous Thromboembolism Prophylaxis - Why Should We Care? Harry Gibbs FRACP FCSANZ Vascular Physician The Alfred Hospital
Venous Thromboembolism Prophylaxis - Why Should We Care? Harry Gibbs FRACP FCSANZ Vascular Physician The Alfred Hospital VTE is common and dangerous 5 VTE is Common VTE Incidence: 1.5 / 1000 per year
More informationSlide 1. Slide 2. Slide 3. Outline of This Presentation
Slide 1 Current Approaches to Venous Thromboembolism Prevention in Orthopedic Patients Hujefa Vora, MD Maria Fox, RN June 9, 2017 Slide 2 Slide 3 Outline of This Presentation Pathophysiology of venous
More informationVTE Management in Surgical Patients: Optimizing Prophylaxis Strategies
VTE Management in Surgical Patients: Optimizing Prophylaxis Strategies VTE in Surgical Patients: Recognizing the Patients at Risk Pathogenesis of thrombosis: Virchow s triad and VTE Risk Hypercoagulability
More informationVenous Thromboembolism Prophylaxis: Checked!
Venous Thromboembolism Prophylaxis: Checked! William Geerts, MD, FRCPC Director, Thromboembolism Program, Sunnybrook HSC Professor of Medicine, University of Toronto National Lead, VTE Prevention, Safer
More informationPerioperative VTE Prophylaxis
Perioperative VTE Prophylaxis Gregory J. Misky, M.D. Assistant Professor of Medicine University Of Colorado Denver You recommend the following 72 y.o. man admitted for an elective R hip repair. Patient
More informationGetting Started Kit VENOUS THROMBOEMBOLISM PREVENTION. Section 2: Evidence-Based Appropriate VTE Prophylaxis
Reducing Harm Improving Healthcare Protecting Canadians VENOUS THROMBOEMBOLISM PREVENTION Getting Started Kit Section 2: Evidence-Based Appropriate VTE Prophylaxis January 2017 www.patientsafetyinstitute.ca
More information10/8/2012. Disclosures. Making Sense of AT9: Review of the 2012 ACCP Antithrombotic Guidelines. Goals and Objectives. Outline
Disclosures Making Sense of AT9: Review of the 2012 ACCP Antithrombotic Guidelines No relevant conflicts of interest related to the topic presented. Cyndy Brocklebank, PharmD, CDE Chronic Disease Management
More informationGeneral. Recommendations. Guideline Title. Bibliographic Source(s) Guideline Status. Major Recommendations
General Guideline Title Prevention of deep vein thrombosis and pulmonary embolism. Bibliographic Source(s) American College of Obstetricians and Gynecologists (ACOG). Prevention of deep vein thrombosis
More informationTHROMBOPROPHYLAXIS: NON-ORTHOPEDIC SURGERY
THROMBOPROPHYLAXIS: NON-ORTHOPEDIC SURGERY OBJECTIVE: To outline a practical approach for the prevention of venous thromboembolism (VTE) in patients undergoing non-orthopedic surgery. BACKGROUND: VTE is
More informationPrevention and management of deep venous thrombosis (DVT) John Fletcher Wound Care Association of New South Wales
Prevention and management of deep venous thrombosis (DVT) John Fletcher Wound Care Association of New South Wales Merimbula, 6 th November 2010 University of Sydney Department of Surgery Westmead Hospital
More informationLow Molecular Weight Heparin for Prevention and Treatment of Venous Thromboembolic Disorders
SURGICAL GRAND ROUNDS March 17 th, 2007 Low Molecular Weight Heparin for Prevention and Treatment of Venous Thromboembolic Disorders Guillermo Escobar, M.D. LMWH vs UFH Jayer s sales pitch: FALSE LMW is
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #23 (NQF 0239): Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) National Quality Strategy Domain: Patient Safety 2018 OPTIONS FOR INDIVIDUAL MEASURES:
More informationMedical Patients: A Population at Risk
Case Vignette A 68-year-old woman with obesity was admitted to the Medical Service with COPD and pneumonia and was treated with oral corticosteroids, bronchodilators, and antibiotics. She responded well
More informationCPT only copyright 2014 American Medical Association. All rights reserved. 12/23/2014 Page 66 of 593
Measure #23 (NQF 0239): Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) National Quality Strategy Domain: Patient Safety 2015 PQRS OPTIONS FOR INDIVIDUAL MEASURES:
More information1. SCOPE of GUIDELINE:
Page 1 of 35 CLINICAL PRACTICE GUIDELINE: Venous Thromboembolism (VTE) Prevention Guideline: Thromboprophylaxis AUTHORIZATION: VP, Medicine Date Approved: May 17, 2012 Date Revised: Vancouver Coastal Health
More informationDENOMINATOR: All surgical patients aged 18 years and older undergoing procedures for which VTE prophylaxis is indicated in all patients
Measure #23 (NQF 0239): Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) National Quality Strategy Domain: Patient Safety 2017 OPTIONS FOR INDIVIDUAL MEASURES:
More informationMeasurement and Improvement of Quality of Cardiovascular Care DR : DEHESTANI
Measurement and Improvement of Quality of Cardiovascular Care DR : DEHESTANI Hospitals For hospitals in the United States, measures of cardiovascular care mandated by the Joint Commission have recently
More informationSUBJECT: LIMB PNEUMATIC COMPRESSION EFFECTIVE DATE: 06/27/13 DEVICES FOR VENOUS REVISED DATE: 06/26/14 THROMBOEMBOLISM PROPHYLAXIS
MEDICAL POLICY SUBJECT: LIMB PNEUMATIC COMPRESSION PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical
More informationVenous Thromboembolism (VTE) Prevention
Venous Thromboembolism (VTE) Prevention 7 VTE Risk Assessment: General Patient Population Assess VTE risk at admission, post-op, and transfer See page 2 for VTE risk assessment among Obstetrical (OB) patients
More informationMeasure #23 (NQF 0239): Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients)
Measure #23 (NQF 0239): Perioperative Care: Venous Thromboembolism (VTE) Prophylaxis (When Indicated in ALL Patients) 2013 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION: Percentage
More informationThese are guidelines only and can be deviated from if it is thought to be in the patient s best interest.
Clinical Guideline Venothromboembolism prophylaxis: Trauma and Orthopaedics Venous thromboembolism (VTE) is a recognised complication associated with inactivity and surgical procedures. Therefore, all
More informationEXTENDING VTE PROPHYLAXIS IN ACUTELY ILL MEDICAL PATIENTS
EXTENDING VTE PROPHYLAXIS IN ACUTELY ILL MEDICAL PATIENTS Samuel Z. Goldhaber, MD Director, VTE Research Group Cardiovascular Division Brigham and Women s Hospital Professor of Medicine Harvard Medical
More informationPostsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
Clinical Position Statement Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis Effective: October 2017 Next Review: September 2018 CLINICAL POSITION STATEMENT Postsurgical
More informationVenothromboembolism prophylaxis: Trauma and Orthopaedics Clinical guideline, V2
Clinical Guideline Venothromboembolism prophylaxis: Trauma and Orthopaedics 11/11/11 TEMPORARY GUIDANCE There is no prophylactic tinzaparin available in the Trust currently. Please substitute enoxaparin
More informationADULT TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) TELEMETRY BED TRANSFER ORDERS 1 of 4
TELEMETRY BED TRANSFER 1 of 4 9 Actual 9 Estimated Patient ID Area Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Transfer to: 10 South Attending Physician: Diagnosis:
More informationFactor Xa Inhibition in the Management of Venous Thromboembolism: Important Safety Information. Important Safety Information (cont d)
Factor Xa Inhibition in the Management of Venous Thromboembolism: The Role of Fondaparinux WARNING: SPINAL/EPIDURAL HEMATOMAS Epidural or spinal hematomas may occur in patients who are anticoagulated with
More informationDVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE)
DVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE) Introduction VTE (DVT/PE) is an important complication in hospitalized patients Hospitalization for acute medical illness
More informationTHROMBOSIS RISK FACTOR ASSESSMENT
Name: Procedure: Doctor: Date: THROMBOSIS RISK FACTOR ASSESSMENT CHOOSE ALL THAT APPLY EACH RISK FACTOR REPRESENTS 1 POINT Age 41 60 years Minor Surgery Planned History of Prior Major Surgery (< 1 month)
More informationGuidelines for Prevention of Venous Thromboembolism in Adults
Guidelines for Prevention of Venous Thromboembolism in Adults First Edition (2011) www.savte.com Dear Colleagues, It is our pleasure to introduce this booklet of guidelines for venous thromboembolism (VTE)
More informationVTE in the Trauma Population
VTE in the Trauma Population Erik Peltz, D.O. February 11 th, 2015 * contributions from Eduardo Gonzalez, M.D. University of Colorado T-32 Research Fellow The problem. VTE - Scope of the Problem One of
More informationSUBJECT: LIMB PNEUMATIC COMPRESSION EFFECTIVE DATE: 06/27/13 DEVICES FOR VENOUS REVISED DATE: 06/26/14, 09/15/15,09/21/17. THROMBOEMBOLISM PROPHYLAXIS
MEDICAL POLICY REVISED DATE: 06/26/14, 09/15/15,09/21/17. PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases,
More informationPREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM
PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM International Consensus Statement 2013 Guidelines According to Scientific Evidence Developed under the auspices of the: Cardiovascular Disease Educational
More informationDr. Steve Ligertwood Dr. Roderick Tukker Dr. David Wilton
Dr. Steve Ligertwood Hospitalist Royal Columbian Hospital Regional Department Head-Hospitalist for Fraser Health Authority Project Lead BC Hospitalist VTE Collaborative Clinical Instructor, UBC School
More informationNICE Guidance: Venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital 1
The College of Emergency Medicine Patron: HRH The Princess Royal Churchill House Tel +44 (0)207 404 1999 35 Red Lion Square Fax +44 (0)207 067 1267 London WC1R 4SG www.collemergencymed.ac.uk CLINICAL EFFECTIVENESS
More informationPrimary VTE Prophylaxis. Ponlapat Rojnuckarin, MD PhD Chulalongkorn University Bangkok, Thailand
Primary VTE Prophylaxis Ponlapat Rojnuckarin, MD PhD Chulalongkorn University Bangkok, Thailand A 70-yr-old female before THA BMI 31 kg/m 2 with varicose vein What do you recommend for VTE prevention?
More informationVenous thrombosis is common and often occurs spontaneously, but it also frequently accompanies medical and surgical conditions, both in the community
Venous Thrombosis Venous Thrombosis It occurs mainly in the deep veins of the leg (deep vein thrombosis, DVT), from which parts of the clot frequently embolize to the lungs (pulmonary embolism, PE). Fewer
More informationADULT CARDIAC SURGERY TELEMETRY BED TRANSFER ORDERS 1 of 4
ADULT CARDIAC SURGERY TELEMETRY BED TRANSFER 1 of 4 9 Actual 9 Estimated Attending Surgeon: Medical Record Number Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART
More information*Corresponding Author:
Audit of venous thromboembolism prophylaxis administered to general surgical patients undergoing elective and emergency operations at National Hospital, Sri Lanka *Migara Seneviratne 1, Asanka Hemachandra
More informationPage: 1 of 13. Post-Surgical Outpatient Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
Last Review Status/Date: March 2014 Page: 1 of 13 Compression Devices for Venous Description Patients undergoing major orthopedic surgery are at increased risk for venous thromboembolism (VTE). Patients
More informationGENERAL SURGICAL ADULT POST-OPERATIVE ORDERS 1 of 4
down ADULT POST-OPERATIVE 1 of 4 9 Actual 9 Estimated Patient ID Area Weight kg 9 Actual 9 Estimated Height cm ALLERGIES: REFER TO ALLERGY PROFILE/ POWERCHART Admit to: Post Anesthesia Care Unit (PACU),
More informationDeep vein thrombosis and its prevention in critically ill adults Attia J, Ray J G, Cook D J, Douketis J, Ginsberg J S, Geerts W H
Deep vein thrombosis and its prevention in critically ill adults Attia J, Ray J G, Cook D J, Douketis J, Ginsberg J S, Geerts W H Authors' objectives To systematically review the incidence of deep vein
More informationWhat You Should Know
1 New 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism: What You Should Know New 2018 ASH Clinical Practice Guidelines on Venous Thromboembolism: What You Should Know The American Society
More informationDisclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None
Disclosures DVT: Diagnosis and Treatment None Susanna Shin, MD, FACS Assistant Professor University of Washington Acute Venous Thromboembolism (VTE) Deep Venous Thrombosis (DVT) Pulmonary Embolism (PE)
More informationChallenges in Anticoagulation and Thromboembolism
Challenges in Anticoagulation and Thromboembolism Ethan Cumbler M.D. Assistant Professor of Medicine Hospitalist Medicine Section University of Colorado Denver May 2010 No Conflicts of Interest Objectives
More informationFatal P.E. Historic 1-2% Current %
Dr. (Prof.) Anil Arora MS (Ortho) DNB (Ortho) Dip SIROT (USA) FAPOA (Korea), FIGOF (Germany), FJOA (Japan) Commonwealth Fellow Joint Replacement (Royal National Orthopaedic Hospital, London, UK) Senior
More informationCancer and Thrombosis
Cancer and Thrombosis The close relationship between venous thromboembolism and cancer has been known since at least the 19th century by Armand Trousseau. Thrombosis is a major cause of morbidity and mortality
More informationWhat evidence exists that describes the efficacy of mechanical prophylaxis for venous thromboembolism (VTE) in adult surgical patients?
July 2015 Rapid Review Evidence Summary McGill University Health Centre: Division of Nursing Research and MUHC Libraries What evidence exists that describes the efficacy of mechanical prophylaxis for venous
More informationVenous Thromboembolism National Hospital Inpatient Quality Measures
Venous Thromboembolism National Hospital Inpatient Quality Measures Presentation Overview Review venous thromboembolism as a new mandatory measure set Outline measures with exclusions and documentation
More informationPage: 1 of 14. Post-Surgical Outpatient Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
Subject: Post-Surgical Outpatient Use of Limb Page: 1 of 14 Last Review Status/Date: March 2015 Post-Surgical Outpatient Use of Limb Compression Devices for Venous Description Patients undergoing major
More informationProtocol. Postsurgical Outpatient Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
Postsurgical Outpatient Use of Limb Compression Devices for (10128) (Formerly Outpatient Use of Limb Pneumatic Compression Devices for ) Medical Benefit Effective Date: 07/01/14 Next Review Date: 03/15
More informationAN AUDIT: THROMBOPROPHYLAXIS FOR TOTAL HIP REPLACEMENT PATIENTS AT NORTHWICK PARK AND CENTRAL MIDDLESEX HOSPITALS
The West London Medical Journal 2010 Vol 2 No 4 pp 19-24 AN AUDIT: THROMBOPROPHYLAXIS FOR TOTAL HIP REPLACEMENT PATIENTS AT NORTHWICK PARK AND CENTRAL MIDDLESEX HOSPITALS Soneji ND Agni NR Acharya MN Anjari
More informationThe Royal College of Emergency Medicine. VTE Risk in Lower Limb Immobilisation in Plaster Cast 2015/2016
The Royal College of Emergency Medicine Clinical Audits VTE Risk in Lower Limb Immobilisation in Plaster Cast Introduction 2015/2016 EXCELLENCE IN EMERGENCY MEDICINE A significant number of patients attend
More informationAre guidelines for anticoagulation useful in cancer patients?
Session 3 Striking a Balance Between Bleeding and the Risk of Thrombosis in Cancer Patients Are guidelines for anticoagulation useful in cancer patients? Sebastian Szmit Department of Pulmonary Circulation
More informationTRANSPARENCY COMMITTEE OPINION. 18 April 2007
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 18 April 2007 ARIXTRA 2.5 mg/0.5 ml, solution for injection in prefilled syringe Pack of 2 (CIP: 359 225-4) Pack of
More informationMEDICAL POLICY SUBJECT: LIMB PNEUMATIC COMPRESSION DEVICES FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS
MEDICAL POLICY SUBJECT: LIMB PNEUMATIC COMPRESSION REVISED DATE: 06/26/14, 10/15/15, 06/16/16, PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered, and medical policy criteria
More informationDVT - initial management NSCCG
Background information Information resources for patients and carers Updates to this care map Synonyms Below knee DVT and bleeding risks Patient with confirmed DVT Scan confirms superficial thrombophlebitis
More informationTarkten A Pharr, MD, FACS 04/26/2018. VTE Prevention Strategies: Is a One Size Fits all Approach Correct?
Tarkten A Pharr, MD, FACS 04/26/2018 VTE Prevention Strategies: Is a One Size Fits all Approach No disclosures... Why do we care? Where is this is the realm of public health concerns? Incidence/Prevalence
More informationUtilization of DVT Prophylaxis in non ICU Hospitalized Patients
Asian Pacific Journal of Tropical Disease (2012)S707-S711 707 Contents lists available at ScienceDirect Asian Pacific Journal of Tropical Disease journal homepage:www.elsevier.com/locate/apjtd Document
More informationReducing the risk of venous thrombo-embolism (VTE) in hospital and after discharge
Reducing the risk of venous thrombo-embolism (VTE) in hospital and after discharge What is a venous thromboembolism (VTE)? This is a medical term that describes a blood clot that develops in a deep vein
More informationUnderstanding thrombosis in venous thromboembolism. João Morais Head of Cardiology Division and Research Centre Leiria Hospital Centre Portugal
Understanding thrombosis in venous thromboembolism João Morais Head of Cardiology Division and Research Centre Leiria Hospital Centre Portugal Disclosures João Morais On the last year JM received honoraria
More informationThromboprophylaxis in hospitalized medical and surgical patients
SSVQ visioconférence -- "THROMBOSE ET CANCER -- 15 Juin, 2018 Thromboprophylaxis in hospitalized medical and surgical patients Susan R. Kahn MD MSc Tier 1 Canada Research Chair Professor of Medicine, McGill
More informationCorporate Medical Policy
Corporate Medical Policy Postsurgical Home Use of Limb Compression Devices for Venous File Name: Origination: Last CAP Review: Next CAP Review: Last Review: postsurgical_home_use_of_limb_ compression_devices_for_vte_prophylaxis
More informationVenous thromboembolism: reducing the risk
Issue date: January 2010 Venous thromboembolism: reducing the risk Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital This guideline
More informationDeveloped by Kathy Wonderly RN, BSPA, CPHQ Performance Improvement Coordinator Developed : October 2009 Most recently updated: September 2011
Developed by Kathy Wonderly RN, BSPA, CPHQ Performance Improvement Coordinator Developed : October 2009 Most recently updated: September 2011 To identify the patients who should receive a beta blocker
More informationProphylaxis for Hospitalized and Non-Hospitalized Medical Patients
Prophylaxis for Hospitalized and Non-Hospitalized Medical Patients An Educational Slide Set American Society of Hematology 2018 Guidelines for Management of Venous Thromboembolism Slide set authors: Eric
More informationRisk Factors for Major Bleeding Non-Ortho Surgical
Risk Factors for Major Bleeding Non-Ortho Surgical General risk factors Active bleeding Previous major bleeding Known, untreated bleeding disorder Severe renal or hepatic failure Thrombocytopenia Acute
More informationPerioperative VTE prophylaxis (ACCP 9 th edition Guidelines) Gamal Marey SUNY Downstate Medical Center 10/16/2014
Perioperative VTE prophylaxis (ACCP 9 th edition Guidelines) Gamal Marey SUNY Downstate Medical Center 10/16/2014 Case Presentation 75 y/o AAM Rectal bleeding & obstructive symptoms 11/12 Obstructing mass
More informationClinical Practice Guideline for Patients Requiring Total Hip Replacement
Clinical Practice Guideline for Patients Requiring Total Hip Replacement Inclusions Patients undergoing elective total hip replacement Exclusions Patients with active local or systemic infection or medical
More informationVenous Thromboembolism (VTE) Prevention and Treatment of VTE in Patients Admitted to Hospital
Please Note: This policy is currently under review and is still fit for purpose. Venous Thromboembolism (VTE) Prevention and Treatment of VTE in Patients Admitted to Hospital This procedural document supersedes
More informationCHAPTER 2 VENOUS THROMBOEMBOLISM
CHAPTER 2 VENOUS THROMBOEMBOLISM Objectives Venous Thromboembolism (VTE) Prevalence Patho-physiology Risk Factors Diagnosis Pulmonary Embolism (PE) Management of DVT/PE Prevention VTE Patho-physiology
More informationAdam Goldfarb, M.A., D.C., D.E.S.S. Introduction
Venous Thromboembolism Prophylaxis following Lower Extremity Orthopedic Surgery: A Review of the Biomedical Research Literature and Evidence-Based Policy in the United States. Adam Goldfarb, M.A., D.C.,
More informationDisclosures. Venous Thromboembolism Prophylaxis: What every orthopaedic surgeon needs to know. Published Guidelines
Venous Thromboembolism Prophylaxis: What every orthopaedic surgeon needs to know Paul F. Lachiewicz, MD Chapel Hill Orthopedic Surgery & Sports Medicine Consulting Professor Duke Orthopaedic Surgery Disclosures
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Postsurgical Home Use of Limb Compression Devices Page 1 of 20 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: See Also: Postsurgical Home Use of Limb Compression
More informationDeep Vein Thrombosis
Deep Vein Thrombosis from NHS (UK) guidelines Introduction Deep vein thrombosis (DVT) is a blood clot in one of the deep veins in the body. Blood clots that develop in a vein are also known as venous thrombosis.
More informationVenous Thromboembolism Prophylaxis After Major Orthopaedic Surgery: A Pooled Analysis of Randomized Controlled Trials
Winner of the AAHKS Award Venous Thromboembolism Prophylaxis After Major Orthopaedic Surgery: A Pooled Analysis of Randomized Controlled Trials Greg A. Brown, MD, PhD The Journal of Arthroplasty Vol. 24
More informationComparison of Venothromboembolism Prophylaxis Practices in a Winnipeg Tertiary Care Hospital to Chest Guidelines: A Quality Improvement Project
Comparison of Venothromboembolism Prophylaxis Practices in a Winnipeg Tertiary Care Hospital to Chest Guidelines: A Quality Improvement Project Dr. Jonathan Laxton, FRCPC, R5 GIM University of Manitoba
More informationVenous Thromboembolism Prophylaxis
I CSI Health Care Guideline: Venous Thromboembolism Prophylaxis I NSTITUTE FOR CLINICAL S YSTEMS IMPROVEMENT Eighth Edition September 2011 The information contained in this ICSI Health Care Guideline is
More informationPostsurgical Outpatient Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
Postsurgical Outpatient Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis Policy Number: 1.01.28 Last Review: 4/2018 Origination: 4/2013 Next Review: 4/2019 Policy Blue Cross and Blue
More informationClinical Policy: Dalteparin (Fragmin) Reference Number: ERX.SPA.207 Effective Date:
Clinical Policy: (Fragmin) Reference Number: ERX.SPA.207 Effective Date: 01.11.17 Last Review Date: 11.17 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationNoCVA Hospital Engagement Network SSI/VTE Safe Surgery Collaborative. December 13, 2012
NoCVA Hospital Engagement Network SSI/VTE Safe Surgery Collaborative December 13, 2012 1 Hospital Acquired VTE Preventing a Preventable Problem It takes a commitment from ALL members of the healthcare
More informationVenous Thrombo-Embolism. John de Vos Consultant Haematologist RSCH
Venous Thrombo-Embolism John de Vos Consultant Haematologist RSCH overview The statistics Pathogenesis Prophylaxis Treatment Agent Duration Incidental VTE Recurrence of VTE IVC filters CVC related thrombosis
More informationVenous thromboembolism - reducing the risk
Venous thromboembolism - reducing the risk Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital NICE guideline Draft for consultation,
More informationCANCER ASSOCIATED THROMBOSIS. Pankaj Handa Department of General Medicine Tan Tock Seng Hospital
CANCER ASSOCIATED THROMBOSIS Pankaj Handa Department of General Medicine Tan Tock Seng Hospital My Talk Today 1.Introduction 2. Are All Cancer Patients at Risk of VTE? 3. Should All VTE Patients Be Screened
More informationPostsurgical Outpatient Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis
Postsurgical Outpatient Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis Policy Number: 1.01.28 Last Review: 4/2019 Origination: 4/2013 Next Review: 4/2020 Policy Blue Cross and Blue
More informationLIMB COMPRESSION DEVICES FOR VENOUS THROMBOEMBOLISM PROPHYLAXIS
PROPHYLAXIS Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs are dependent
More informationDeep venous thrombosis and pulmonary embolism in joint replacement surgery
Deep venous thrombosis and pulmonary embolism in joint replacement surgery Even though joint replacement surgery is an effective procedure and in expert hands yields a low complication rate, deep venous
More informationDEEP VEIN THROMBOSIS (DVT): TREATMENT
DEEP VEIN THROMBOSIS (DVT): TREATMENT OBJECTIVE: To provide an evidence-based approach to treatment of patients presenting with deep vein thrombosis (DVT). BACKGROUND: An estimated 45,000 patients in Canada
More informationClinical Policy: Dalteparin (Fragmin) Reference Number: ERX.SPA.207 Effective Date:
Clinical Policy: (Fragmin) Reference Number: ERX.SPA.207 Effective Date: 01.11.17 Last Review Date: 02.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationAspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty: The EPCAT II Trial
Aspirin or Rivaroxaban for VTE Prophylaxis after Hip or Knee Arthroplasty: The EPCAT II Trial Wednesday, June 6, 2018, 2:00PM ET Guest Author: David R. Anderson, MD Presenter: Sara Vazquez, PharmD Moderators:
More information