Introduction:
Venous thromboembolism (VTE) is a common
complication in patients undergoing surgery.
Postoperative deep vein thrombosis (DVT) of the lower limbs is often
asymptomatic; therefore, it is inappropriate to rely on early diagnosis and
treatment of postoperative thromboembolism.
In many patients, fatal pulmonary embolism (PE) is the first clinical
manifestation of postoperative VTE.1,2
The risk for VTE in surgical patients is determined by the
combination of individual predisposing factors and features of the specific
type of surgery. More extended use of
prophylaxis, early mobilization, and improved perioperative care have reduced
the risk of VTE in surgical patients. However, many patients remain at high risk
for VTE because of advanced age, more extensive operative procedures, and
greater medical comorbidities.2 The
Institute of Medicine considers failure to provide appropriate VTE prophylaxis
to hospitalized, at-risk patients a medical error.1 The Agency for Healthcare Research and Quality (AHRQ) ranks
VTE prophylaxis as among the most important interventions to
improve patient safety.1 If used appropriately, prophylaxis is cost
effective, as it reduces the incidence of symptomatic thromboembolic events,
which require costly diagnostic procedures and prolonged anticoagulation
therapy. Venous Thromboembolism (VTE) has an incidence of 1 per 1,000
person-years.1,2 The Agency for Healthcare Research and
Quality (AHRQ) Healthcare Cost and Utilization Projects' estimate of
incremental inpatient cost are $10,000 per DVT and $20,000 per PE. 1
VTE is one of the three major causes of maternal morbidity and mortality in the United States. For pregnant women, the risk of VTE is 4-5 times higher than for non-pregnant women, and this risk is at least twice as much following Cesarean delivery. Assessing risk and addressing prevention is part of the Maternal Harm Prevention Initiative.3
Resources:
AHRQ Preventing Hospital-Acquired Venous Thromboembolism Toolkit
AHRQ "Your Guide to Preventing and Treating Blood Clots" Patient Education Booklet
Society of Hospital Medicine Venous Thromboembolism Resource Room
Institute for Healthcare Improvement (IHI): Venous Thromboembolus (VTE) Prevention & Treatment Institute for Healthcare Improvement (IHI)
HRET Resources:
HRET Venous Thromboembolism (VTE) Change Package 2016
HRET Venous Thromboembolism (VTE) Top Ten Checklist 2017
HRET VTE Webinars
