Prevention of Deep Vein Thrombosis Discussion Paper
Prevention of Deep Vein Thrombosis Discussion Paper
Problem Statement
Due to insufficient evidence for the efficacy of anticoagulant prophylaxis as a method for prevention of venous thromboembolism in hospitalized patients, there has been under-utilization of the anticoagulant prophylaxes like heparin and lovenox. Due to a lack of education about and risk factors for thromboembolism, this complication continues to be a major cause of deaths among hospitalized patients in the US.
Significance of the problem
Hospitalized patients at high-risk for Venous thromboembolism (VTE) may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE) even before the diagnosis is suspected. Prevention of Deep Vein Thrombosis There is clinical evidence that appropriately used thromboprophylaxis has a desirable risk/benefit ratio and is cost effective. Thromboprophylaxis provides an opportunity to improve patient outcomes and reduce hospital costs. Prevention of Deep Vein Thrombosis The vast majority of patients admitted to a critical care unit have a major risk factor for VTE, and many may have multiple risk factors including advanced age, serious medical illness or recent surgical procedures or trauma. The use of thromboprophylaxis has been clinically demonstrated to be efficacious in preventing deep venous thrombosis in these patients(Abdel-Razeq, 2010).
PICO Question and Purpose
This paper aims to answer the question: Does the Use of anticoagulant prophylaxes such as lovenox and heparin prevent venous thromboembolism (DVT) in hospitalized patients?
In order to learn how to best prevent and treat VTE in hospitalized patients, two journal articles, one investigating the risk factors for VTE in patients (Abdel-Razeq, 2010) and one that determined the most effective pharmaceutical agents for treating VTE (Wein, Wein, Haas, Shaw, &Krum, 2007) , were reviewed. The research should help in identification of the best prophylaxis for prevention of VTE among hospitalized medical patents. In addition, the research should help in providing sufficient evidence for supporting the efficacy of the prophylaxis.Thus provide the medical practitioners with the necessary confidence to administer the appropriate anticoagulant drugs in order to prevent DVT in hospitalized patients.
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Best Methodology for Answering the Question
In order to answer the question, the best approach was to search for studies that have investigated the subject and critically analyze the methodologies used and match with the findings. In addition, assessment of the peer-reviewed articles and journals was an instrumental aid in establishing a perspective that agrees with the professional aspect of scientific process.
Synthesis of Literature
A literature review was undertaken by Abdel-Razeq (2010) in order to determine risk factors for VTE in hospitalized patients. The matrices revealed that in western countries, 2 to 3 of 1000 inhabitants encounters VTE annually, a number that has remained consistent since the 1980’s. Additionally, some studies have showed that 10-26% of patients admitted to med-surgunitencounter VTE with the absence of prophylaxis. While VTE is typically not deadly, it can cause long term health complications. Being able to identify high-risk patients and treating them with a preventative dose of the appropriate prophylactic is the best way to prevent VTE. A review of the cases of medically ill patients who encountered VTE showed that age was a significant factor for VTE, especially those 75 and older. Prevention of Deep Vein Thrombosis Other VTE risk factors included heart attack, cancer, and stroke. Patients who have had VTE previously are especially at risk. For females, “risk factors include hormonal therapy with oral contraceptive pills, hormone replacement therapy, and selective estrogen receptor modulators like Tamoxifen and Raloxifene.”(Abdel-Razeq, 2010, pp. 195-196).
The study by Wein et al. (2007) was carried out to investigate which pharmacological agents are most effective in the prevention of VDT. In this study, an analysis of 36 studies was done by searching the MEDLINE and other registers for controlled trials from 1950 to 2006. In the results, the researchers found that LMWH has a lower DVT risk than unfractionated heparin.
Findings
A review of the literature reveals that it is possible to reduce the instance of VTE in medically ill patients. The first step is in setting up a protocol in order to identify high-risk patients. The second step is in identifying the appropriate prophylaxis treatment for the patient.
The next step needed to help decrease the prevalence of VTE and DVT is to create a protocol that could be used by medical personal to identify patients that are at risk for VTE and the appropriate prophylaxis treatment for each type of patient, depending on their medical history and condition. Continuous education and training of all health care providers is key to the success of a VTE protocol.
Conclusion
After carrying out the careful investigation of literature and assessment of various studies, there is sufficient evidence pointing to the efficacy of low-molecular-weight heparin (LMWH) in prevention of DVT among the hospitalized medical patients. It would thus be appropriate to recommend LMWH to be used for treatment of hospitalized medical students for prevention of VDT (Wein, et al., 2007). Additionally, strategies to improve VTE prophylaxis in medically ill patients was suggested, including the establishment of a “VTE Prophylaxis Multidisciplinary Team” to identify high-risk patients for prophylaxis treatment, are suggested (Abdel-Razeq, 2010). For more information on the analyzed studies see appendix.
References
Abdel-Razeq H. (2010).Venous thromboembolism prophylaxis for hospitalized medical patients, current status and strategies to improve.Annals of Thoracic Medicine5, 195-200.
Wein, L Wein S., Haas S. J., Shaw, J & Krum H. (2007). Pharmacological Venous Thromboembolism Prophylaxis in Hospitalized Medical Patients: A Meta-analysis of Randomized Controlled Trials.Arch Intern Med. 167(14):1476-1486
