This document discusses deep vein thrombosis (DVT) prophylaxis. It defines DVT as clot formation in the deep veins of the legs, with an annual incidence of 1-2 per 1000 people in the US. Risk factors include surgery, injury, prolonged bed rest, estrogen use, and inherited clotting disorders. Signs and symptoms include leg pain, swelling, and difficulty breathing. Diagnosis involves duplex ultrasound and other imaging tests. Complications include pulmonary embolism and post-thrombotic syndrome. Prophylaxis includes mechanical methods, aspirin, anticoagulants, and stratified prophylaxis based on patient risk factors. The goal of prophylaxis is to prevent DVT and its

1. DVT PROPHYLAXIS
Dr. E M. Regis Jr.
Dept. Of Orthopaedics
10/08/15

2. Overview
Definition
Incidence
Aeitology/ Risk Factors
Pathophysiology
Signs/ Symptoms
Diagnosis
Complications
Prophylaxis
Conclusion

3. Definition
thrombus (clot) formation predominately in the
deep veins of the legs.
eg. femoral vein, popliteal vein

4. Incidence
1-2 per 1000 annually in the United States
60,000-100,000 die of DVT {10-30% within 1st
month of diagnosis}

5. Aeitology/ Risk Factors
Virchow’s Triad
a) stasis
b) hypercoagulability
c) vessel wall damage (intima)

7. INJURY TO VEIN;
fractures
severe muscle injury
major surgery (abdominal, pelvis, hip or legs)
SLOW BLOOD FLOW;
confinement to bed
limited movement
sitting for prolong periods with crossed legs
paralysis

8. INCREASED ESTROGEN;
birth control pills
HRT sometimes used after menopause
Pregnancy, up to 6 weeks postpartum
OTHER FACTORS;
previous DVT or PE
family history of DVT or PE
age (risk increase as age increases)
obesity
catheter located in a central vein
inherited clotting disorders (protein c deficiency, antithrombin deficiency)

10. Signs & Symptoms
pain or tenderness
warmth
swelling
redness or discoloration
distention of surface veins
difficulty breathing (S.O.B)
tachycardia or irregular heart beat
chest pain or discomfort
anxiety
haemoptysis
hypotension/ lightheadedness

11. Diagnosis
HISTORY & PHYSICAL EXAMINATION
CHEST X-RAY
ECG
Labs including D-dimers
DUPLEX ULTRASOUND
VENOGRAPHY
spiral CT chest
V:Q scan (ventilation/perfusion)
pulmonary angiogram

12. Complications
Pulmonary Embolism
Death
Post-thrombotic Syndrome

13. Prophylaxis
Mechanical
compression stockings
intermittent pneumatic compression devices
ivc filters

15. Pharmacological
1. Platelet Active Drugs {aspirin 50-100mg/d}
2. Courmarins {Warfarin}
3. Heparins (UFH)
4. Low Molecular Weight Heparins (LMWH)
{Enoxaparin}
5. Factor Xa Inhibitors {Rivaroxaban}

16. DVT Prophylaxis Based on Risk
Stratification Levels
1 point assigned to following:
age 41-60yrs
minor surgery
history of major surgery within 1 month
pregnancy or postpartum within 1 month
varicose veins
inflammatory bowel disease
swelling of legs
obesity
oral contraceptives, patch or HRT

17. 2 points assigned to the following:
age >60yrs
malignancy or current chemo or radiation therapy
major surgery (>45min)
laparoscopic surgery (>45min)
confined to bed > 72hrs
immobilizing cast shorter than 1 month
central venous access <1month
tourniquet time >45mins

18. 3 points assigned to the following:
age >75yrs
history of DVT or PE
family history of thrombosis
Factor V Leiden/activated protein C resistance
medical patient with risk factors of MI, CHF or COPD
congenital or acquired thrombophillia

19. 5 points assigned to the following:
major, elective lower extremity arthoplasty, total knee
replacement, total hip replacement
hip, pelvis or leg fracture within 1 month
stroke within 1 month
multiple trauma within 1 month
acute spinal cord injury with paralysis within 1 month

20. Risk Group Classification for Orthopaedic
Patients

21. Low Risk Patients;
no specific prophylaxis is required other than early and
aggressive mobilisation
Moderate Risk Patients;
low dose UFH {LDUF q12hrs}, LMWH {<3,400 U qd}, and
IPC
High Risk Patients;
low dose UFH q8h, LMWH {>3400 U qd}, with or without IPC
Very High Risk Patients;
LMWH {>3400 U qd}, fondaparinux, and coumarins (INR 2-3).
Dose-adjusted low-dose UFH or LMWH may be used with or
without IPC.

24. Conclusion
Based on history and physical examination findings, there should
be a high index of suspicion in diagnosing DVT confirmed with
labs and necessary investigations.
Aim should be geared towards prevention than treatment.
Prophylaxis is tailored independently based on numerous of
patient factors.
Treatment is a multidisciplinary approach involving chest
physicians and primary surgical team.

25. References
www.google.com/images
Deep Venous Thrombosis Prophylaxis In Orthopedic
Surgery, DAVID A FORSH MD. August 15, 2014
www.sages.org/publications/guidelines
Venous thromboembolism prophylaxis.- National
Guideline
Antithrombotic Guidelines, 9th ED| Guidelines &
Consensus. American College of Chest Physicians