Venous Thromboembolism Prevention and management

Prevention and Management of VTE in surgery

1. VTE: Prevention & Management Kirengo mbcHb mba msc mrcs

2. Introduction Significant morbidity and mortality (PE 10% 30-day mortality; 5% DVT) DVT, PE, post-thrombotic syndrome Genetic and Environmental risk factors: hospitalization, surgery Prevent Timely treatment

3. Epidemiology

4. Epidemiology

5. PATHOPHYSIOLOGY: Anticoagulation mechanisms: antithrombin, proteins c & s, tissue factor pathway inhibitor sys, fibrinolytic system Acquired causes of hypercoagulability: Antiphospholipid syndrome, Heparin induced thrombocytopenia (>50% drop in plts )

6. COAGULATION CASCADE

7. Natural history of VTE

8. Diagnosis: DVT Unilateral leg pain, swelling, pitting oedema, mild erythema, cyanosis, mild pyrexia Homan’s sign (unreliable) Only ¼ of patients Ix for VTE symptoms subsequently confirmed Wells score + D-dimer Imaging: venogram, venous uss , impedance plethysmography, CT, MRA

9. Wells score

10. Diagnosis: PE Breathlessness, tachypnoea, pleuritic pain, apprehension Tachycardia, cough, haemoptysis Leg pain, DVT Wells score + D-dimer Imaging: CXR (exclude other diagnosis), ECG (tachycardia, <10% S1,Q3,T3, exclusion), V/Q scanning, CTPA, Echo, MRI ( ce -MRA), duplex USS (pregnancy)

11. WELLS SCORE

12. Prevention Commissioning for Quality and Innovation (CQUIN) payment framework mandated a 95% target for completion of VTE risk assessment for hospital inpatients within NHS 2018 NICE Guidelines Mechanical methods: TEDS, Flowtrons Pharmacological anticoagulants: LMWH Duration 1 vs 4 wks ?

13. VTE proforma

14. Future of compression stockings? Compression stockings cost the NHS in England approximately £63 million per year *Lack of evidence supporting use of GCS in day cases (Systematic review,2021)

15. Treatment Symptom rx Supportive care Prevent extension Prevent recurrence Anticoagulation

16. Hospital Guideline