Mutidisciplinary cooperation on VTE prevention and managment

Size: px
Start display at page:

Download "Mutidisciplinary cooperation on VTE prevention and managment"

Transcription

1 Mutidisciplinary cooperation on VTE prevention and managment TAO YANG Dpartment of vascular surgery Shanxi DAYI Hospita Tai yuan Shanxi China

2 Disclosure Speaker name: Tao Yang... I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest

3 VTE is a major public health problem Acute symptoms, fatal PE, Posthrombotic Syndrome are major causes of disability and societal burden

4 The risk of developing VTE depends on the condition and/or procedure for which the patient is admitted and on any predisposing risk factors elderly smoke obesity clinical/ family history of VTE recent surgery, trauma critical patients acute myocardium infarction patients with heart-lung failure ischemia stroke Severe pulmonary disease cancer oral contraceptive pregnant/postpartum tumor chemotherapy diabetes rheunatic diseases inflammatory bowel disease nephrotic syndrome hormon replacement therapy metabolic syndrome Acute infectious diseases long-haul travel permanent pacemaker long-term CVC

5 Why VTE prvention is so important? 1. VTE is an important cause of death in hospitalised patients. 2. Treatment of non-fatal symptomatic VTE is associated with a considerable cost to the health service.

6 VTE prevention Gudelines from different countries or orgnizations ACCP CMA NCCN NICE

7 VTE Prevention got increasing attention in CHINA

8 M internal medicine surgical department VTE management team obstetrics-gynecology oncology department imaging department D T laboratory medicine ultrasonic department invasive department vascular surgery

9 Recommended procedures for prevention of venous thromboembolism in hospitalized patients

10 Risk assessment -VTE Padua score for inpatient in intrenal medicine Risk Factors score Active cancer 3 Previous venous thromboembolism (VTE) 3 Reduced mobility 3 Known thrombophilic condition 3 Recent trauma or/and surgery 2 Age 70 years 1 Heart and/or respiratory failure 1 Acute myocardial infarction or stroke 1 Acute infection and/or rheumatologic disorder 1 Obesity (BMI 30Kg/m 2 ) 1 Hormonal treatment 1 Clinical probability simplified score Low risk High risk <4 4 Barbar S, Noventa F, Rossetto V,et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score[J].J Thromb Haemost, 2010, 8(11):

11 Risk assessment -VTE Caprini score for surgical inpatient 0 very low risk 1~2 low risk 3~4 medium risk 5 High risk Caprini JA. Why thrombosis prophylaxis fails]]. Vase Ds Manag. 2009, 6(2),47-51

12 Risk assessment -VTE Khorana score for inpatient with malignancy Type of cancer Fisk Factors Points Stomach of pancreatic 2 Lung,lymphoma,gynecologic,bladder,or testicular 1 Platelet count 350,000/mm 3 1 Hemoglobin<10 g/dl 1 White-cell count >11,000/mm 3 1 BMI 35Kg/m 2 1 Clinical probability simplified score Low risk 0 Medium risk 1~2 High risk Prevention of thrombosis in children with cancer and tunnelled CVCs,JCO June 10, 2013 vol. 31 no

13 Risk assessment -Bleeding Regard hospitalised patients as being at risk of bleeding if they have any of the following risk factors: Active bleeding Acquired bleeding disorders (such as acute liver failure) Concurrent use of anticoagulants known to increase the risk of bleeding (such as warfarin with INR higher than 2) Lumbar puncture/epidural/spinal anaesthesia expected within the next 12 hours Lumbar puncture/epidural/spinal analgesia within the previous 4 hours Acute stroke Thrombocytopenia (platelets less than /l) Uncontrolled systolic hypertension (180 mmhg or higher) Untreated inherited bleeding disorders (such as haemophilia and von Willebrand s disease). Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital,Venous Thromboembolism.NICE Clinical Guidelines, No

14 VTE prophylaxis recommendations VTE Risk category VTE prophylaxis recommendations High risk Pharmacological VTE prophylaxis Continue pharmacological VTE prophylaxis until the patient no longer has significantly reduced mobility Medium risk High/medium VTE risk with high bleeding risk low risk Pharmacological VTE prophylaxis Mecahnic prophylaxis until the patient can have pharmacological VTE prophylaxis Basic prophylaxis

15 VTE prevention informed consent to hospitalised patient both benefit and risk of pharmacological and mechanical prophylaxis DVT-PE self risks Risk of complications Postthrombotic syndrome CTEPH Retiring VTE and disabling Preventive measures risk Hemorrhage and bruising HIT Cerebral /gastrointestinal hemorrhage death The occurrence of venous thromboembolism Sign informed consent

16 Basic prophylaxis 1. VTE knowledge education 2. Improve lifestyles education:quit smoking, abstain from alcohol, control blood sugar and lipids 3. Soft and delicate operation, avoid intimal injury 4. Avoiding dehydration

17 mechanical prophylaxis Ankle pump movement Foot impulse Anti embolisim stocking Intermittent pneumatic compression device

18 pharmacological prophylaxis

19 Vena caval filters Temporary or retrievable IVCF to patients who are at very high risk of VTE and for whom mechanical and pharmacological VTE prophylaxis are contraindicated.

20 Clinical variable Active cancer (treatment ongoing or within previous 6 months or palliative) 1 Paralysis, paresis, or recent plaster immobilization of the lower extremities 1 Recently bedridden for 3 days or more, or major surgery within the previous 12 weeks requiring general or regional anesthesia Localized tenderness along the distribution of the deep venous system 1 Entire leg swelling 1 Calf swelling at least 3 cm larger than that on the asymptomatic leg (measured 10 cm below the tibial tuberosity) Pitting edema confined to the symptomatic leg 1 Collateral superficial veins (non-varicose) 1 Previously documented DVT 1 Score Alternative diagnosis at least as likely as DVT ) -2 Clinical probability simplified score DVT likely DVT unlikely Diagnosis of DVT Wells Score Wells PS, Anderson DR, Rodger M, Forgie MA, Kearon C, Dreyer JF, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ. Evaluation of D-Dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003; 349:

21 Strategy for diagnosis of DVT Diagnostic algorithm using clinical probability, D- dimer and ultrasound in patients with suspected DVT. Diagnostic algorithm using clinical probability of DVT likely, D-dimer and ultrasound in patients with suspected DVT.

22 Diagnosis of PE Wells score Clinical variable Clinical signs and symptoms of DVT (minimum of leg swelling and pain with palpation of the deep veins) Score 3 An alternative diagnosis is less likely than PE 3 Heart rate greater than 100 beats per minute 1.5 Immobilisation (for more than 3 days) or surgery in the previous four weeks 1.5 Previous DVT/PE 1.5 Haemoptysis 1 Malignancy (on treatment, treated in the last 6 months, or palliative) 1 Clinical probability simplified score PE likely PE unlikely 4 3 Wells PS, Anderson DR, Rodger M, Forgie MA, Kearon C, Dreyer JF, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ. Evaluation of D-Dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003; 349:

23 Strategy for diagnosis of PE Strategy for diagnosis of PE using CTPA in patients who are PE likely. Strategy for diagnosis of PE using CTPA in patients who are PE unlikely.

24 Treatment and Management on DVT Etiological removal anticoagulant Inferior vena caval filters Prevent thrombus propagation Prevent PTE, reduce morbidity protect CDT Prevent DVT RECURRENCE thrombectomy PMT SUR Relieve patients' symptoms Prevent Post thrombotic syndrome Iliocaval stents Placement compression therapy

25 Treatment and Management on PE Konstantinides SV, Torbicki A, Perrier A, et al ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014.

26 The proportion of patients who had VTE prophylaxis was increasing year by year 120,00% 100,00% 80,00% 60,00% 40,00% 20,00% 96,89% 89,08% 94,54% 85,43% 86,24% 84,32% 78,56% 92,40% 79,65% 73,54% 69,32% 70,89% 79,50% 67,83% 74,30% 63,34% 59,31% 73,40% 61,76% 64,45% 58,65% 59,71% 55,23% 47,87% 50,10% 47,83% 45,89% 42,76% 40,42% 38,76% 0,00% In 2015 In 2016 In 2017

27 Incidence of VTE in high risk group was disreasing year by year 35,00% 30,00% 28,87% 25,00% 20,00% 15,00% 10,00% 5,00% 19,59% 19,43% 19,34% 17,72% 16,67% 14,54% 14,09% 13,87% 13,38% 13,03% 11,53% 13,65% 12,54% 13,75% 10,06% 11,56% 10,93% 9,23% 10,84% 9,46% 9,08% 8,87% 8,08% 9,68% 7,32% 8,87% 7,24% 7,69% 6,23% 0,00% In 2015 In 2016 In 2017

28 SUMMARY 1. Comprenhnsive assessment 2. Nomative VTE prevention 3. Meticilous surgery 4. Careful nursing 5. Timely diagnosis 6. Professional treatment Prevention Diagnosis Treatment Mutidisciplinary cooperation

29

30 Mutidisciplinary cooperation on VTE prevention and managment TAO YANG Dpartment of vascular surgery Shanxi DAYI Hospita Tai yuan Shanxi China

NICE Guidance: Venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital 1

NICE 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 information

Diagnostic Algorithms in VTE

Diagnostic Algorithms in VTE Diagnostic Algorithms in VTE Mark H. Meissner, MD Department of Surgery University of Washington School of Medicine Overutilization of Venous Duplex U/S 1983-1993 (Zweibel et al, Australasian Rad, 1995)

More information

1.0 PATIENT CARE Including Physical Healthcare

1.0 PATIENT CARE Including Physical Healthcare SECTION: 1.0 PATIENT CARE Including Physical Healthcare POLICY /PROCEDURE: 1.33 NATURE AND SCOPE: SUBJECT: PROCEDURE - TRUST WIDE VENOUS THROMBOEMBOLISM (VTE) This procedure details Venous Thromboembolism

More information

Reducing 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 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 information

CHAPTER 2 VENOUS THROMBOEMBOLISM

CHAPTER 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 information

CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM. Gordon Lowe Professor of Vascular Medicine University of Glasgow

CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM. Gordon Lowe Professor of Vascular Medicine University of Glasgow CURRENT & FUTURE THERAPEUTIC MANAGEMENT OF VENOUS THROMBOEMBOLISM Gordon Lowe Professor of Vascular Medicine University of Glasgow VENOUS THROMBOEMBOLISM Common cause of death and disability 50% hospital-acquired

More information

VTE Management in Surgical Patients: Optimizing Prophylaxis Strategies

VTE 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 information

Venous thrombosis is common and often occurs spontaneously, but it also frequently accompanies medical and surgical conditions, both in the community

Venous 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 information

Comparison 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 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 information

Mabel Labrada, MD Miami VA Medical Center

Mabel Labrada, MD Miami VA Medical Center Mabel Labrada, MD Miami VA Medical Center *1-Treatment for acute DVT with underlying malignancy is for 3 months. *2-Treatment of provoked acute proximal DVT can be stopped after 3months of treatment and

More information

Objectives. Venous Thromboembolism (VTE) Prophylaxis. Case VTE WHY DO IT? Question: Who Is At Risk?

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 information

Deep Vein Thrombosis and Pulmonary Embolism: Patient Information

Deep Vein Thrombosis and Pulmonary Embolism: Patient Information Deep Vein Thrombosis and Pulmonary Embolism: Patient Information A Deep Vein Thrombosis (DVT) and a Pulmonary Embolism (PE) are both disorders of unwanted blood clotting. Unwanted blood clots can occur

More information

Dr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital Foundation Trust

Dr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital Foundation Trust MANAGEMENT OF PATIENTS WITH DEEP VEIN THROMBOSIS (DVT) IN THE COMMUNITY SETTING & ANTICOAGULATION CLINICS THE PAST, PRESENT AND THE FUTURE Dr. Riaz JanMohamed Consultant Haematologist The Hillingdon Hospital

More information

DVT PROPHYLAXIS IN HOSPITALIZED MEDICAL PATIENTS SAURABH MAJI SR (PULMONARY,MEDICINE)

DVT 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 information

VTE Prophylaxis. NEW NICE guidance. Providing venous thromboembolism (VTE) prophylaxis to all at risk hospital patients

VTE Prophylaxis. NEW NICE guidance. Providing venous thromboembolism (VTE) prophylaxis to all at risk hospital patients NEW NICE guidance NICE guidance (MTG19) supports the use of the geko device for people who have a high risk of VTE and for whom pharmacological or other mechanical methods of VTE prevention are impractical

More information

VENOUS THROMBOEMBOLISM: DURATION OF TREATMENT

VENOUS THROMBOEMBOLISM: DURATION OF TREATMENT VENOUS THROMBOEMBOLISM: DURATION OF TREATMENT OBJECTIVE: To provide guidance on the recommended duration of anticoagulant therapy for venous thromboembolism (VTE). BACKGROUND: Recurrent episodes of VTE

More information

Misunderstandings of Venous thromboembolism prophylaxis

Misunderstandings 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 information

DVT - initial management NSCCG

DVT - 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 information

VTE Prophylaxis. NICE guidance. Providing venous thromboembolism (VTE) prophylaxis to all at risk hospital patients

VTE Prophylaxis. NICE guidance. Providing venous thromboembolism (VTE) prophylaxis to all at risk hospital patients NICE guidance NICE guidance (MTG19) supports the use of the geko device for people who have a high risk of VTE and for whom pharmacological or other mechanical methods of VTE prevention are impractical

More information

These are guidelines only and can be deviated from if it is thought to be in the patient s best interest.

These 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 information

THROMBOSIS RISK FACTOR ASSESSMENT

THROMBOSIS 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 information

Venous thromboembolism: reducing the risk

Venous 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 information

Prevention 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 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 information

INDICATIONS FOR THROMBO-PROPHYLAXIS AND WHEN TO STOP ANTICOAGULATION BEFORE ELECTIVE SURGERY

INDICATIONS 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 information

Venothromboembolism prophylaxis: Trauma and Orthopaedics Clinical guideline, V2

Venothromboembolism 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 information

Venous thromboembolism - reducing the risk

Venous 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 information

Venous 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 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 information

Proper Diagnosis of Venous Thromboembolism (VTE)

Proper Diagnosis of Venous Thromboembolism (VTE) Proper Diagnosis of Venous Thromboembolism (VTE) Whal Lee, M.D. Seoul National University Hospital Department of Radiology 2 nd EFORT Asia Symposium, 3 rd November 2010, Taipei DVT - Risk Factors Previous

More information

Cancer and Thrombosis

Cancer 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 information

Anticoagulation for prevention of venous thromboembolism

Anticoagulation 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 information

Suspected Deep Vein Thrombosis (DVT) Pathway for Non Pregnant patients Updated November 2016, with new D-dimer reference range

Suspected Deep Vein Thrombosis (DVT) Pathway for Non Pregnant patients Updated November 2016, with new D-dimer reference range Suspected Deep Vein Thrombosis (DVT) Pathway for Non Pregnant patients Updated November 2016, with new D-dimer reference range Suspect a DVT? Complete a Two-level DVT Wells score on ICE system (see page

More information

PULMONARY EMBOLISM (PE): DIAGNOSIS AND TREATMENT

PULMONARY EMBOLISM (PE): DIAGNOSIS AND TREATMENT PULMONARY EMBOLISM (PE): DIAGNOSIS AND TREATMENT OBJECTIVE: To provide a diagnostic algorithm and treatment options for patients with acute pulmonary embolism (PE). BACKGROUND: Venous thromboembolism (VTE)

More information

*Corresponding Author:

*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 information

Disclosures. DVT: Diagnosis and Treatment. Questions To Ask. Dr. Susanna Shin - DVT: Diagnosis and Treatment. Acute Venous Thromboembolism (VTE) None

Disclosures. 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 information

Duration of anticoagulation

Duration of anticoagulation Duration of anticoagulation P. Fontana Service d angiologie et d hémostase Hôpitaux Universitaires de Genève Pomeriggio formativo in coagulazione, Bellinzona, 19.10.2017 Conflict of interest AstraZeneca,

More information

Deep Vein Thrombosis

Deep 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 information

DEEP VEIN THROMBOSIS (DVT): TREATMENT

DEEP 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 information

Simplified approach to investigation of suspected VTE

Simplified approach to investigation of suspected VTE Simplified approach to investigation of suspected VTE Diagnosis of DVT and PE THSNA 2016, Chicago 15 April 2016 Clive Kearon, McMaster University, Canada Relevant Disclosures Research Support/P.I. Employee

More information

Slide 1. Slide 2. Slide 3. Outline of This Presentation

Slide 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 information

Venous thromboembolic diseases: diagnosis, management and thrombophilia testing (2012) NICE guideline CG144

Venous thromboembolic diseases: diagnosis, management and thrombophilia testing (2012) NICE guideline CG144 Venous thromboembolic diseases: diagnosis, management and thrombophilia testing (2012) NICE guideline CG144 Appendix A: Summary of new evidence from Summary of evidence from previous year Diagnosis Diagnostic

More information

Venous Thromboembolism. Prevention

Venous 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 information

With All the New Drugs, This is How I Treat Acute DVT and Superficial Phlebitis

With All the New Drugs, This is How I Treat Acute DVT and Superficial Phlebitis BRIGHAM AND WOMEN S HOSPITAL With All the New Drugs, This is How I Treat Acute DVT and Superficial Phlebitis Gregory Piazza, MD, MS Division of Cardiovascular Medicine Brigham and Women s Hospital April

More information

Deep vein thrombosis (DVT) and pulmonary embolism (PE) advice for ophthalmic surgery patients

Deep vein thrombosis (DVT) and pulmonary embolism (PE) advice for ophthalmic surgery patients Deep vein thrombosis (DVT) and pulmonary embolism (PE) advice for ophthalmic surgery patients What is a deep vein thrombosis (DVT)? A DVT is a blood clot that forms within a vein deep in the leg but can

More information

Suspected Deep Vein Thrombosis (DVT) Assessment

Suspected Deep Vein Thrombosis (DVT) Assessment CHI no... First name... DOB... /... /... Last name... Sex: c M c F Address...... Telephone... or attach addressograph label here Hospital/Location: c Hairmyres c Monklands c Wishaw Other (specify)... Ward/Base...

More information

1. SCOPE of GUIDELINE:

1. 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 information

Canadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC

Canadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC Canadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC 1 st workshop: update to VTE guidelines in 2016 2 nd workshop: VTE controversies + new horizons André Roussin MD, FRCP, CSPQ CHUM

More information

The Johns Hopkins Hospital Patient Information. How Do I Prevent Blood Clots? Venous Thromboembolism (VTE) Deep Vein Thrombosis (DVT)

The Johns Hopkins Hospital Patient Information. How Do I Prevent Blood Clots? Venous Thromboembolism (VTE) Deep Vein Thrombosis (DVT) Page 1 of 11 Venous Thromboembolism () What is a clot or Venous Thromboembolism ()? Blood clots are called Venous Thromboembolism (). There are 2 main types: is a clot in a deep vein, usually an arm or

More information

Chapter 1. Introduction

Chapter 1. Introduction Chapter 1 Introduction Introduction 9 Even though the first reports on venous thromboembolism date back to the 13 th century and the mechanism of acute pulmonary embolism (PE) was unraveled almost 150

More information

ADULT TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) TELEMETRY BED TRANSFER ORDERS 1 of 4

ADULT 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 information

Epidemiologia e clinica del tromboembolismo venoso. Maria Ciccone Sezione di Ematologia e Fisiopatologia della Coagulazione

Epidemiologia e clinica del tromboembolismo venoso. Maria Ciccone Sezione di Ematologia e Fisiopatologia della Coagulazione Epidemiologia e clinica del tromboembolismo venoso Maria Ciccone Sezione di Ematologia e Fisiopatologia della Coagulazione Thrombophilia may present clinically as one or more of several thrombotic manifestations

More information

VENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK?

VENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK? VENOUS THROMBOEMBOLISM AND CORONARY ARTERY DISEASE: IS THERE A LINK? Ayman El-Menyar (1), MD, Hassan Al-Thani (2),MD (1)Clinical Research Consultant, (2) Head of Vascular Surgery, Hamad General Hospital

More information

8,9,10. Deep venous thrombosis (DVT) is clotting of blood in a deep vein of Pulmonary embolism

8,9,10. Deep venous thrombosis (DVT) is clotting of blood in a deep vein of Pulmonary embolism CANCER ASSOCIATED THROMBOSIS DIAGNOSIS OF VTE In patients with cancer-associated thrombosis, landmark studies have demonstrated that effective prophylaxis and treatment of thrombosis reduces morbidity

More information

PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM

PREVENTION 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 information

PRIMARY THROMBOPROPHYLAXIS IN AMBULATORY CANCER PATIENTS: CURRENT GUIDELINES

PRIMARY THROMBOPROPHYLAXIS IN AMBULATORY CANCER PATIENTS: CURRENT GUIDELINES PRIMARY THROMBOPROPHYLAXIS IN AMBULATORY CANCER PATIENTS: CURRENT GUIDELINES Mario Mandalà, MD Unit of Clinical Research Department of Oncology and Haematology Papa Giovanni XXIII Hospital Cancer Center

More information

Deep vein thrombosis: diagnosis, prevention and treatment

Deep vein thrombosis: diagnosis, prevention and treatment Deep vein thrombosis: diagnosis, prevention and treatment Catherine Bagot BSc, MD, MRCP, FRCPath and Campbell Tait BSc, FRCP, FRCPath Deep vein thrombosis can lead to significant morbidity and has well-recognised

More information

Cover Page. The handle holds various files of this Leiden University dissertation.

Cover Page. The handle  holds various files of this Leiden University dissertation. Cover Page The handle http://hdl.handle.net/1887/21764 holds various files of this Leiden University dissertation. Author: Mos, Inge Christina Maria Title: A more granular view on pulmonary embolism Issue

More information

Venous Thromboembolism Prophylaxis

Venous 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 information

DVT Diagnosis. Reference methods. Whole leg Ultrasonography. Predictive values. Page 1. Diagnosis of 1 st time symptomatic DVT.

DVT Diagnosis. Reference methods. Whole leg Ultrasonography. Predictive values. Page 1. Diagnosis of 1 st time symptomatic DVT. DVT Diagnosis Ulf Nyman Associate Professor Lund University Department of Radiology East Division (Kristianstad, HässleholmH Trelleborg, Ystad) Sweden Diagnosis of 1 st time symptomatic DVT Scientific

More information

Prevention and treatment of venous thromboembolic disease

Prevention and treatment of venous thromboembolic disease REVIEW Prevention and treatment of venous thromboembolic disease SUSAN McNEILL AND CATHERINE BAGOT Awareness of the risk factors for venous thromboembolic (VTE) disease and timely administration of thromboprophylaxis

More information

Venous interventions in DVT

Venous interventions in DVT Venous interventions in DVT Sriram Narayanan Chief of Vascular and Endovascular Surgery, Tan Tock Seng Hospital A/Prof of Surgery, National University of Singapore ANTI-COAGULATION LMWH Warfarin x 6m Acute

More information

Disclosures. What is a Specialty Vein Clinic? Prevalence of Venous Disease. Management of Venous Disease: an evidence based approach.

Disclosures. What is a Specialty Vein Clinic? Prevalence of Venous Disease. Management of Venous Disease: an evidence based approach. Management of Venous Disease: an evidence based approach Disclosures Ed Boyle, MD Andrew Jones, MD Dr. Ed Boyle and Dr. Andrew Jones disclose Grants/research support: Medtronic, BTG International, Clearflow,

More information

Updates in Medical Management of Pulmonary Embolism and Deep Vein Thrombosis. By: Justin Youtsey, Elliott Reiff, William Montgomery, Grant Finlan

Updates in Medical Management of Pulmonary Embolism and Deep Vein Thrombosis. By: Justin Youtsey, Elliott Reiff, William Montgomery, Grant Finlan Updates in Medical Management of Pulmonary Embolism and Deep Vein Thrombosis By: Justin Youtsey, Elliott Reiff, William Montgomery, Grant Finlan Objectives Describe the prevalence of PE and DVT as it relates

More information

What You Should Know

What 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 information

PULMONARY EMBOLISM/VTE CARE PROCESS MODEL

PULMONARY EMBOLISM/VTE CARE PROCESS MODEL PULMONARY EMBOLISM/VTE CARE PROCESS MODEL IMCP FALL CONFERENCE 2017 Scott Stevens, MD Co-Director, Thrombosis Clinic & Thrombosis Research Group Intermountain Medical Center Professor of Clinical Medicine

More information

The Royal College of Emergency Medicine. VTE Risk in Lower Limb Immobilisation in Plaster Cast 2015/2016

The 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 information

D-dimer Value more than 3.6 μg/ml is Highly Possible Existence Deep Vein Thrombosis

D-dimer Value more than 3.6 μg/ml is Highly Possible Existence Deep Vein Thrombosis Original Contribution This is Advance Publication Article Kurume Medical Journal, 60, 00-00, 2013 D-dimer Value more than 3.6 μg/ml is Highly Possible Existence Deep Vein Thrombosis SHINICHI NATA, SHINICHI

More information

How long to continue anticoagulation after DVT?

How long to continue anticoagulation after DVT? How long to continue anticoagulation after DVT? Dr. Nihar Ranjan Pradhan M.S., DNB (Vascular Surgery), FVES(UK) Consultant Vascular Surgeon Apollo Hospital, Jubilee Hills, Hyderabad (Formerly Faculty in

More information

CANCER 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 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 information

PE service. 65 years old lady. What would you do next? Risk stratification. What would you do next? Regional College Lecture PE Management

PE service. 65 years old lady. What would you do next? Risk stratification. What would you do next? Regional College Lecture PE Management PE service Regional College Lecture PE Management Update in medicine (Eastern) Cambridge 29 th June 2017 Dr Rachel M Limbrey DM FRCP University Hospital Southampton NHS Foundation Trust Ambulatory acute

More information

Approach to Thrombosis

Approach to Thrombosis Approach to Thrombosis Theera Ruchutrakool, M.D. Division of Hematology Department of Medicine Siriraj Hospital Faculty of Medicine Mahidol University Approach to Thrombosis Thrombosis: thrombus formation

More information

Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine

Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine Dr. Rami M. Adil Al-Hayali Assistant Professor in Medicine Venous thromboembolism: pulmonary embolism (PE) deep vein thrombosis (DVT) 1% of all patients admitted to hospital 5% of in-hospital mortality

More information

GENERAL SURGICAL ADULT POST-OPERATIVE ORDERS 1 of 4

GENERAL 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 information

Inferior Venacaval Filters Valuable vs. Dangerous Valuable Annie Kulungowski. Department of Surgery Grand Rounds March 24, 2008

Inferior Venacaval Filters Valuable vs. Dangerous Valuable Annie Kulungowski. Department of Surgery Grand Rounds March 24, 2008 Inferior Venacaval Filters Valuable vs. Dangerous Valuable Annie Kulungowski Department of Surgery Grand Rounds March 24, 2008 History of Vena Cava Filters Virchow-1846-Proposes PE originate from veins

More information

Frequently Asked Questions about Cancer Associated Thrombosis

Frequently Asked Questions about Cancer Associated Thrombosis + Frequently Asked Questions about Cancer Associated Thrombosis Atlantic Canada Oncology Group Annual Meeting June 13 th, 2015 Sudeep Shivakumar, Dalhousie University + Conflict of Interest Disclosures

More information

Understanding 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 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 information

ADULT CARDIAC SURGERY TELEMETRY BED TRANSFER ORDERS 1 of 4

ADULT 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

I-Ming Chen, MD. Endovascular Stenting for Palliative Treatment of Superior Vena Cava Syndrome in End-Stage Lung Cancer

I-Ming Chen, MD. Endovascular Stenting for Palliative Treatment of Superior Vena Cava Syndrome in End-Stage Lung Cancer Endovascular Stenting for Palliative Treatment of Superior Vena Cava Syndrome in End-Stage Lung Cancer I-Ming Chen, MD Division of CardioVascular Surgery Taipei Veterans General Hospital, Taiwan (Live

More information

Interventional Treatment VTE: Radiologic Approach

Interventional Treatment VTE: Radiologic Approach Interventional Treatment VTE: Radiologic Approach Hae Giu Lee, MD Professor, Dept of Radiology Seoul St. Mary s Hospital The Catholic University of Korea Introduction Incidence High incidence: 250,000-1,000,000/year

More information

Updates in venous thromboembolism. Cecilia Becattini University of Perugia

Updates in venous thromboembolism. Cecilia Becattini University of Perugia Updates in venous thromboembolism Cecilia Becattini University of Perugia News for VTE Diagnosis Treatment the acute phase the agents Pulmonary embolism: diagnosis Vein ultrasonography Meta-analysis 15

More information

Prevention of Venous Thromboembolism

Prevention of Venous Thromboembolism 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

More information

Implications from the ACCP 2012 Consensus Guidelines for the Management of Thrombosis: a case based approach

Implications from the ACCP 2012 Consensus Guidelines for the Management of Thrombosis: a case based approach Implications from the ACCP 2012 Consensus Guidelines for the Management of Thrombosis: a case based approach Prof. I. Baumgartner Head Clinical and Interventional Angiology About the ACCP guidelines Widely

More information

Thromboprophylaxis in Adult General Medical Patients - Guidelines for Management

Thromboprophylaxis in Adult General Medical Patients - Guidelines for Management Thromboprophylaxis in Adult General Medical Patients - Guidelines for Management Adapted from the Worcestershire Acute Hospitals NHS Trust Guideline WAHT-MED-010 Version: Final Ratified by: Provider Quality

More information

Acute Pulmonary Embolism and Deep Vein Thrombosis. Barbara LeVarge MD Beth Israel Deaconess Medical Center Pulmonary Hypertension Center COPYRIGHT

Acute Pulmonary Embolism and Deep Vein Thrombosis. Barbara LeVarge MD Beth Israel Deaconess Medical Center Pulmonary Hypertension Center COPYRIGHT Acute Pulmonary Embolism and Deep Vein Thrombosis Barbara LeVarge MD Beth Israel Deaconess Medical Center Pulmonary Hypertension Center Acute PE and DVT No disclosures. Acute PE and DVT Learning objectives

More information

Preventing Blood Clots in Adult Patients

Preventing Blood Clots in Adult Patients Manchester Royal Eye Hospital Surgical Services Information for Patients Preventing Blood Clots in Adult Patients This leaflet will give you information on how to reduce the risk of developing blood clots

More information

What is the risk of venous thromboembolism (VTE) in patients treated by an Outpatient Parenteral Antimicrobial Therapy (OPAT) Service?

What is the risk of venous thromboembolism (VTE) in patients treated by an Outpatient Parenteral Antimicrobial Therapy (OPAT) Service? What is the risk of venous thromboembolism (VTE) in patients treated by an Outpatient Parenteral Antimicrobial Therapy (OPAT) Service? David A. Barr; Sharon Irvine; Neil D. Ritchie; Jay McCutcheon; R.

More information

Discussion Leader: Doug Bias, M.D.

Discussion Leader: Doug Bias, M.D. In low-risk patients with isolated calf DVT (IDDVT), what is the morbidity risk of treating with repeat ultrasound/observation versus anticoagulation? Discussion Leader: Doug Bias, M.D. Clinical Scenario:

More information

DVT and Pulmonary Embolus. Dr Piers Blombery BSc(Biomed), MBBS (Hons), FRACP, FRCPA Consultant Haematologist Peter MacCallum Cancer Centre

DVT and Pulmonary Embolus. Dr Piers Blombery BSc(Biomed), MBBS (Hons), FRACP, FRCPA Consultant Haematologist Peter MacCallum Cancer Centre DVT and Pulmonary Embolus Dr Piers Blombery BSc(Biomed), MBBS (Hons), FRACP, FRCPA Consultant Haematologist Peter MacCallum Cancer Centre Overview Structure of deep and superficial venous system of upper

More information

Pulmonary Thromboembolism

Pulmonary Thromboembolism Pulmonary Thromboembolism James Allen, MD Epidemiology of Pulmonary Embolism 1,500,000 new cases per year in the United States Often asymptomatic 300,000 deaths per year DVT or PE present in 10% of ICU

More information

Pulmonary Embolism. Pulmonary Embolism. Pulmonary Embolism. PE - Clinical

Pulmonary Embolism. Pulmonary Embolism. Pulmonary Embolism. PE - Clinical Pulmonary embolus - a practical approach to investigation and treatment Sam Janes Wellcome Senior Fellow and Respiratory Physician, University College London Background Diagnosis Treatment Common: 50 cases

More information

NOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section.

NOTE: 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 information

PROGNOSIS AND SURVIVAL

PROGNOSIS AND SURVIVAL CANCER ASSOCIATED THROMBOSIS PROGNOSIS AND SURVIVAL Since French internist Armand Trousseau reported the occurrence of mysterious thrombotic disorders in cancer patients in the mid-19th century, the link

More information

DOPPLER ULTRASOUND OF DEEP VENOUS THROMBOSIS

DOPPLER ULTRASOUND OF DEEP VENOUS THROMBOSIS TOKUDA HOSPITAL SOFIA DOPPLER ULTRASOUND OF DEEP VENOUS THROMBOSIS MILENA STANEVA, MD, PhD Department of vascular surgery and angiology Venous thromboembolic disease continues to cause significant morbidity

More information

Venous Thrombo-Embolism (VTE)

Venous Thrombo-Embolism (VTE) Venous Thrombo-Embolism (VTE) Information for service users and carers RDaSH leading the way with care Older People s Mental Health Services Reducing risk of unwanted blood clots whilst in hospital About

More information

Thrombophilia. Diagnosis and Management. Kevin P. Hubbard, DO, FACOI

Thrombophilia. Diagnosis and Management. Kevin P. Hubbard, DO, FACOI Thrombophilia Diagnosis and Management Kevin P. Hubbard, DO, FACOI Clinical Professor of Medicine Kansas City University of Medicine and Biosciences-College of Osteopathic Medicine Kansas City, Missouri

More information

Company Introduction

Company Introduction Company Introduction We are the leading company of various pneumatic medical systems since 1986. We are exporting our products to 60 countries. We provide the products with high quality and competitive

More information

Venous Thromboembolism Policy (VTE)

Venous Thromboembolism Policy (VTE) Venous Thromboembolism Policy (VTE) DOCUMENT CONTROL: Version: 2 Ratified by: Clinical Effectiveness Committee Date ratified: 5 November 2013 Name of originator/author: Modern Matron St John s Hospice

More information

Early 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 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 information

Understanding Best Practices in Anticoagulation Therapy in Patients with Venous Thromboembolism. Rajat Deo, MD, MTR

Understanding Best Practices in Anticoagulation Therapy in Patients with Venous Thromboembolism. Rajat Deo, MD, MTR Understanding Best Practices in Anticoagulation Therapy in Patients with Venous Thromboembolism Rajat Deo, MD, MTR Director of Translational Research in Cardiac Arrhythmias Division of Cardiovascular Medicine

More information

Prevention of Venous Thromboembolism

Prevention of Venous Thromboembolism Prevention of Venous Thromboembolism Reference No: P_CS_05 Version 2.4 Ratified by: LCHS Trust Board Date ratified: 27 th January 2015 Name of originator / author: Medical Director Name of responsible

More information