Cardinal Health

Preventing Venous Thromboembolism: A Healthcare Professional Guide to Intervention 11 Risk Assessment. Being hospitalised is a major risk factor for the development of Venous Thromboembolism (VTE). Patients with decreased mobility - due to bedrest or recovery - or who experience blood vessel trauma - due to surgery or other serious injury - are more likely to develop blood clots. • Risk factors are cumulative: increased risk factors = increased risk of VTE. 17 • American College of Chest Physicians recommends that every hospital develop a formal written, institution wide VTE prophylaxis policy. 11 • Combined modalities are more effective in reducing the incidence of VTE than single modalities. 18 • About 50%–75% of people admitted to hospital have at least one risk factor for VTE, while 40% have three or more. 5 • Patients with cancer are four to seven times more likely to develop VTE than are patients without cancer. 19 • Cancer-associated thrombosis is the second leading cause of death in cancer patients after disease progression. 19 • The risk for development of VTE in cancer patients undergoing operations is about twice that for patients without cancer. 20 • Thrombophilia is found in approximately 50% of women with a VTE during pregnancy. 20 • There is 4 to 5-fold increased risk of developing a VTE in pregnancy. 21 • VTE was the leading cause of direct maternal death in Australia 2006–2016. 21 • The greatest risk is in the weeks immediately after birth. 21 • When compared to control subjects, obese individuals had an odds ratio of 2.33 for developing VTE. 13 • Obesity, is associated with increased thrombin formation and decreased fibrinolysis. 22 All admitted patients should have a VTE risk assessment as part of their hospital admission, and they should receive optimal VTE prophylaxis according to their level of risk, and existing contraindications to prophylaxis. Low Risk (1 factor) Moderate Risk (2 factors) High Risk (3-4 factors) Highest Risk (5 or more factors) No Specific Measures Early Ambulation IPC or LDUH (q12h) or LMWH or GCS GCS * and IPC or LDUH (q8h) or LMWH GCS * and IPC + (LDUH or LMWH) or ADH or LMWH Oral Anticoagulants Examining Physician’s Signature: Date: STEP 5 Please Check The Modality(s) Chosen From The List Below, and Sign / Date. STEP 4 RECOMMENDED PROPHYLACTIC REGIMENS FOR EACH RISK GROUP: STEP 3 TOTAL RISK FACTOR SCORE (BASELINE + ADDITIONAL) STEP 2 RISK FACTORS ASSOCIATED WITH PATIENT: STEP 3 TOTAL ADDITIONAL RISK FACTOR SCORE STEP 3 BASELINE RISK FACTOR SCORE (If Score = 5, go to Step 4) Administer within 24 hours of admission Patient’s Name: Age: Sex: Diagnosis: Admission: Elective Type of surgery planned: Emergency Graduated compression stockings (GCS) Intermittentpneumatic compression (IPC) Foot Impulse Technology AdjusteddoseHeparin (ADH) Contraindication to anticoagulants? Yes No If yes, explain: ........................................................................................... Lowmolecularweightheparin (LMWH) (Regimen:..............................................) Lowdoseunfractionatedheparin (LDUH) (Regimen:...............................................) OralAnticoagulant (Regimen:.........................................................) Other (..............................................................) NoProphylaxis Thrombosis Risk Assessment for Surgical & Medical Patients Affix Patient Stamp Here Basedon:GPGlaggett,MD et al: PreventionofVenousThromboembolism.Chest1998;114:531S-560S;1997 Inte Thromboembolism,GuidelinesAccording to ScientificEvidence;andCaprini JA,Arcelus JI etal:Clinical as ThrombHemost 1991;17(suppl 3):304-312. Preliminarydraft submitted forpublication. Provided as Vasc 376-05-12 Score 1 Factor (1 factor unless noted) Age 41 to 60 years Ageover 60 years (2 factors) HistoryofDVT /PE (3 factors) Historyofpriormajor surgery Pregnancy,orpostpartum (<1month) Malignancy (2 factors) Varicose veins Inflammatoryboweldisease Obesity (>20%of idealbodyweight) Oral contraceptivesorhormone replacement therapy Score 1 Factor Score 2 Factor Score 3 Factor Score 5 Factor Minor surgery Minor surgeryMajor surgery (>45min.) Laparoscopic surgery (>45min.) Patients confined tobed>72hrs Immobilisingplaster cast Central venous access Major surgerywith Congestiveheart failureor Myocardial infarctionor Severe sepsis / infection Medicalpatientwith additional risk factors Electivemajor lower extremity arthroplasty Hip,pelvis,or leg facture Stroke Multiple trauma Acute spinal cord injury (paralysis) HYPERCOAGULABLE STATES (THROMBOPHILIA) INHERITED (score3 factors foreach) ACQUIRED (score3 factors foreach) FactorV Leiden /Activated proteinC resistance Antithrombin IIIdeficiency ProteinCor Sdeficiency Dysfibrinogenemia Prothrombin20210A Homocysteinemia Lupusanticoagulant Antiphospholipid antibodies Myeloproliferativedisorders Disordersofplasminogen& plasminactivation Heparin-induced thrombocytopenia Hyperviscosity syndrome Homocysteinemia * CombiningGCSwithotherprophylacticmethods (LDUH, LMWHor IPC)maygivebetterprotection thananymodalityalone. † Datademonstratesbenefitof Foot Impulse Technology in total jointarthroplasty. Plantar PneumaticCompression canalsobeusedwhen IPC isnot feasible, including leg trauma. STEP 1 RISK FACTORS ASSOCIATED WITH CLINICAL SETTING: Choosenomore thanoneof thebelow listeddisease statesor associatedhospital service todetermine thebaseline risk factor score. Vasc 376-05-12RiskPad 2.indd 1 Risk Assessment Tool.