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An audit on the appropriate completion of the venous thromboembolism (VTE) risk assessment and adequate thromboprophylaxis durin - Dissertation Example

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An analysis of medical screening procedures for Venous Thromboembolism and related disorders during pregnancy INTRODUCTION Venous thromboembolism is the leading cause of maternal mortality in the United States. (VTE), includes deep vein thrombosis (DVT) and pulmonary embolism, and these conditions collectively represent a significant source of morbidity and mortality…
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An audit on the appropriate completion of the venous thromboembolism (VTE) risk assessment and adequate thromboprophylaxis durin
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Download file to see previous pages Certain patient subsets display VTE pathologies of idiopathic causes, with no apparent identifiable risk factors. Therapeutic anticoagulation is the cornerstone of management in all patients with VTE, in many cases, standard anticoagulants such as heparin are included as therapeutic options in normal practice. (Schulman et al 2009) Adjunctive treatments, such as thrombolysis and the use of vena cava filters, are prescribed in certain cases. Pregnancy is among several risk factors for deep venous thrombosis, in addition to minor injuries and surgery. (Van Stralen et al. 2008) But those with a familial history of thrombophilia-related blood conditions are at an increased risk. (American College of Obstetricians 2000) Most physicians do not recommend general screening for the patient population at large, and several studies attest to the need for a regimen of targeted testing for VTE conditions only when a battery of predisposing factors is extant. ( Robertson et al. 2006) (Osinbowale et al. 2010) Of particular instance in this case is the degree to which proper screening is conducted for pregnant women, both upon admittance to Maternity, and postpartum. SCREENING Diagnostic testing for inherited or acquired thrombophilic conditions is advisable in the presence of personal or family history indicating heightened risk factors. The Factor V Leiden and prothrombin G20210A mutations are the most common genetic thrombophilic disorders, and antiphospholipid antibody syndrome is the most clinically significant acquired defect. Venous thromboembolism often results from the interplay between a series of risk factors. 50% of pregnant women with also exhibit thrombophilia. (Nelson-Piercey 2004) (Zotz et al. 2003) Understanding these VTE risks increases the probability of timely prevention and diagnosis. Virchow’s triad refers to 3 abnormalities that promote thrombogenesis: hypercoagulability, stasis, and endothelial dysfunction or injury. (Van Stralen et al. 2008) (Osinbowale et al. 2010) Several predisposing factors alter ? 1 components of Virchow’s triad. In a systematic analysis of 1231 consecutive patients treated for VTE, 96% exhibited > 1 recognized risk factor. Venous thromboembolism risk factors as may be hereditary or acquired. (Osinbowale et al. 2010) (Dresang et al. 2008) Osinbowale et al. 2010 Provides a ranking of predisposing risks from to lowest to highest in terms of probability: 1.) Obesity LOW 2.) Elderly 3.) Varicose veins (Varicosity) 4.) Laparoscopy 5.) Stasis (Immobility, due to long-term bed rest) 6.) CV catheterization 7.) Any other medical condition requiring hospitalization 8.) Previous VTE states 9.) Paralytic stroke 10.) Hormone Replacement Therapy 11.) Oral contraceptives, and pregnancy itself 12.) Arthroscopic knee surgery 13.) Malignancy and chemotherapy 14.) Spinal Cord injury 15.) Multiple traumas 16.) Major general surgery 17.) Major orthopedic surgery 18.) Long bone fractures, or fractures of hips and pelvis. HIGH Clinical examinations may prove unreliable, therefore decisions in terms of treatment and/or screening tests must be based upon signs, symptoms, and preexisting risk factors. In this manner, patients are grouped into low, moderate, or high clinical probability of risk. (Sandler et al. 1984) Clinical symptoms of VTE disorders may be subtle and difficult to distinguish from gestational edema, though pain, warmth, ...Download file to see next pagesRead More
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