文档介绍：Thromboembolic disease-risk&prophylaxis
"clinically silent"
prevention-by removing risk factors(early mobilization) or by prophylaxis.
The incidence of DVT ranges from13-31%. factors that increase the risk of DVT are shown in. In as many as 50% of cases of acute pulmonary embolism,the source DVT has been undiagnosed.
Low risk:
Surgery lasting<30 min and age<40yr. Medical illness(except MI,stroke)
Moderate or high risk:
Major surgery and age>40yr.
1
Hip or knee or pelvic fracture/surgery.
2
Major trauma or burns.
3
Acute myocardial infarction,stroke,end stage renal disease.
4
History of venous thromboembolism.
5
Malignancy (particularly abdomen or pelvis)
6
Prolonged immobilization eg:use of muscle relaxants
,sedatives,mechanical ventilation.
7
Use of femoral venous catheters,
use of high dose vasopressors.
8
Prophylaxis
DVT prophylaxis is mended for those at moderate or high risk
pression stockings
Intermittent pression boots
Heparin (unfractionated)
5000IU SC every 12 hours. Laboratory tests of coagulation status are not monitored.
Low-molecular-weight(LMW)heparin
4000-6000 AXa U daily
Mesh filters
Treatment
Full anticoagulation with unfractionated heparin- bolus of 5000-10000U and infusion of 1000-2000U per hour to keep activated partial thromboplastin time to 2 times normal.
LMW heparin(eg enoxaparine 1mg/kg q12h SC)can be used as an alternative.