Cardinal Health

Preventing Venous Thromboembolism: A Healthcare Professional Guide to Intervention 14 Signs, Symptoms, Diagnosis & Management. VTE can occur without any warning signs or symptoms and can go unrecognised and undiagnosed by a healthcare professional. Symptoms that do appear may be associated with either DVT or PE. Deep Vein Thrombosis (DVT). • Pain or tenderness, often starting in the calf • Swelling, including the ankle or foot • Redness or noticeable discoloration • Increased warmth of the leg Diagnosis of DVT. In addition to using the risk factor assessment and taking clinical observation into account, physicians rely on diagnostic test methods to diagnose DVT. Some options include the Wells clinical prediction rule, D dimer blood test, Doppler Ultrasound and Venography. Treatment of DVT. Depending on patient risk factors and the severity of the DVT a patient will most likely go home on oral anticoagulants or low molecular weight heparin (LMWH) for a period of 3-6 months. During this time patients should be encouraged to ambulate and exercise as well as wearing treatment grade compression stockings if directed by their clinician. If the clot is significant the treating doctor may elect to do a thrombectomy or use catheter directed thrombolysis. Patients should also be educated on the symptoms of PE and what to do if they experience any of these symptoms. Pulmonary Embolism (PE). • Unexplained shortness of breath • Rapid breathing • Chest pain (may be worse upon deep breath) • Rapid heart rate Diagnosis of PE. In addition to clinical observation, some of the diagnostic options for PE include D-dimer testing, Arterial Blood Gases (ABG), Ventilation Perfusion (V/Q) Scan, Pulmonary angiogram and CT Pulmonary angiogram (CTPA). Treatment of Pulmonary Embolism. Large clots or repeated small clots may increase the patient’s risk of death, therefore to increase the chances of patient survival and recovery, a physician must diagnose and treat the pulmonary embolism quickly. Treatment of PE typically includes anticoagulant medication such as heparin, LMWH or oral anticoagulants. Depending on the severity of the PE, surgical embolectomy or catheter directed thrombolysis may need to be performed. Despite heparin prophylaxis, asymptomatic DVT still occurs in 8–10% of general surgical patients and in 15–30% after hip or knee arthroplasty. 25 The majority of PE including fatal PE occur in patients with asymptomatic DVT. 26 In almost 25%of people affected, sudden death is the first clinical sign of PE. 5