John D. Chovan, James R. Cacchillo
Venous Thromboembolism, Blood Clots, Post-thrombotic Syndrome
Cardiovascular Diseases | Medical Pathology | Medicine and Health Sciences | Nursing
•The term venous thromboembolism (VTE) is defined as a syndrome that collectively comprises both deep vein thrombosis (DVT) and pulmonary embolism (PE). Each year approximately 350,000-900,000 people in the United States develop VTE and approximately 100,000 people die according to this cause (Streiff et al., 2014). Unfortunately, the reoccurrence rate for VTE remains very high, with an estimated risk of 10%-30% of VTE patients will develop another VTE within five years of the first incident (Streiff et al., 2014). •Deep vein thrombosis (DVT) is blood clot that forms in a large vein, usually in areas of slow blood flow such as the leg or pelvis. Clots can form in the deep veins (DVT) or superficial veins (called superficial thrombophlebitis or phlebitis). Superficial blood clots rarely cause serious problems. •A blood clot can detach or embolize, becoming mobile in the bloodstream. This embolism can travel to other places most lethally the heart (resulting in a myocardial infarction), the brain (resulting in a stroke) or the lungs (causing a pulmonary embolism). •A DVT however, does NOT cause heart attack or stroke. Due to the anatomy of blood flow throughout the body, a DVT can only cause a PE. A blood clot in the artery, termed an arterial thrombosis, can embolize to cause a heart attack or stroke (Centers for Disease Control and Prevention [CDC], 2014). •DVT causes significant morbidity and mortality. The most common complication associated with DVT is post-thrombotic syndrome (PTS) which occurs in approximately one-third of patients that experience DVT (Bonner & Johnson, 2013). PTS can cause symptoms of chronic pain, heaviness, and swelling to the affected extremity that can result in development of venous leg ulcers in severe cases (Bonner & Johnson, 2014). PTS can significantly affect a person quality of life and lead to serious disability. •While other risk factors exist, the incidence rate of DVT is known to increase in association with surgical procedures particularly orthopedic surgery. Without prophylaxis, the incidence rate of documented DVT in the orthopedic surgical patients is reported to range from 50%-60% (Snyder, 2008). As part of ongoing efforts to increase the efficiency and overall cost-effectiveness of hospital operations, the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission adopted standardized performance measures for hospitals. Among other performance measures, VTE related total hip replacement and total knee replacement surgeries were added to the “never event” list defined by CMS as “preventable medical errors that result in serious consequences for the patient” (Baser, Supina, Sengupta, Wang, & Kwong, 2010).CMS no longer reimburses hospitals for VTE associated with total hip and knee replacement surgeries” (Baser, Supina, Sengupta, Wang, & Kwong, 2010). •Although guidelines exist for the prevention and management of DVT, their implementation remains problematic and VTE incident rates within the United States remains high. Several prospective analyses have shown that VTE guidelines are not being routinely followed and this gap between guidelines and actual medical practice can partly be explained by physician knowledge, attitudes or beliefs (Baser, Supina, Sengupta, Wang, & Kwong, 2010). •Research within this topic was performed in anticipation to gain a deeper understanding of DVT along with the implications for nursing care. Inquiry and discussion within this area serves to bring to light the importance of researching the most current and relevant evidenced based practice guidelines regarding DVT risk assessment, signs and symptoms, pathophysiology and the significance of DVT pathophysiology in orthopedic patients.
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