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Venous Thromboembolism:

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Venous Thromboembolism: Contemporary Management Anthony J. Comerota, MD, FACS, RVT Director, Jobst Vascular Center Adjunct Clinical Professor, University of Michigan – PowerPoint PPT presentation

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Title: Venous Thromboembolism:


1
Venous Thromboembolism
Contemporary Management
Anthony J. Comerota, MD, FACS, RVT
Director, Jobst Vascular Center
Adjunct Clinical Professor, University of
Michigan
2
Spectrum of Venous Thromboembolism
Management
Biologic onset
Asymptomatic
Symptomatic
Outcome
Primary prophylaxis
Screening
Clinical suspicion
Treatment
3
DVT Prevalence Hospitalized Patients
Patient Group DVT () Medical 10
-20 General surgery 15-40 Major gynecologic
surgery 15-40 Major urologic surgery 15-40 Ne
urosurgery 15-40 Stroke 20-50 Hip/knee
arthroplasty, hip fracture surgery 40-60 Major
trauma 40-80 Spinal cord injury 60-80 Criti
cal care 10-80
Geerts WH et al. Chest 2004126(3
suppl)338S-400S
4
Pulmonary embolism remains the most common
preventable cause of death in the hospital.
Hull 1986
5
Venous Thrombosis Risk
Without Prophylaxis?
Outcome
Risk Profile
PE
DVT
Risk Factor Equivalents
Risk
lt0.01
lt10
0-1
Low
0.1-0.5
10-30
2-3
Moderate
0.5-1.0
30-40
4-5
High
1-5
40-80
gt6
Highest
? Modified from Geerts W et al CHEST 2001
Includes calf DVT
6
Venous Thrombosis Prophylaxis
Risk Factor Equivalents
1 Factor
Age 40-59 Bed Confinement gt48 hrs Varicose
Veins Leg Edema/ulcer/statis Obesity (gt20 ideal
wt.) MI (current) CHF (current) Severe COPD
Crystalliods (gt5L/24 hrs) Confining travel
gt4hrs Pregnancy/Postpartum (1 month) Inflammatory
bowel disease Severe infection Estrogen
Rx Operation gt2 hrs
7
Venous Thrombosis Prophylaxis
Risk Factor Equivalents
2 Factors
3 Factors
Age gt 60 Stroke (current) Trauma Pelvic
operation Joint replacement Hip
fracture Malignancy Pelvic/long bone
fracture Hypercoag. state
Hx DVT/PE Spinal Cord Injury
8
Rudolf Virchow
Creator of Cellular Pathology 1821-1902
Presented the classic triad of the factors
leading to DVT
  1. Venostasis
  2. The hypercoagulable state
  3. Vein wall injury

9
The Beginning
10
Stasis
A Permissive Factor
  • On table phlebography
  • Decrease velocity
  • Decrease pulsatility
  • Retention of dye in valves
  • Radioactive NaCl studies
  • Decreased velocity
  • Femoral vein blood flow
  • Decreased up to 50
  • Gen. Anes.
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