Venous thromboembolism (VTE) includes deep venous thrombosis (DVT) and pulmonary thromboembolism (PTE), both of which are manifestations of the same disease in different stages. The risk of fatal PTE in the acute phase of DVT and the occurrence of post-thrombotic syndrome in the long term not only affect the quality of life of patients or even threaten their lives, but also pose hidden dangers to clinical work. Therefore, effective DVT prevention is necessary. The currently accepted prevention of venous thromboembolism includes: basic prevention, physical prevention and drug prevention.
I. Preventive measures of VTE
(A) Basic prevention measures
This measure is applicable to all populations, throughout the consultation and treatment process. It includes the following measures.
1. Scientific health education.
2. Psychological guidance at the right time.
3.Improve lifestyle.
4. Drink appropriate amount of water, appropriate rehydration.
5.Eat a light diet and eat more fruits and vegetables.
6.Keep bowel movement smooth and reduce toilet time.
7.Avoid wearing tight clothing for long-distance travelers and move the lower limbs at the right time.
8.Actively treat the original disease.
9.Preventive measures for surgical patients should be taken: maintain correct body position; operate with caution during surgery; reduce the time to tie tourniquet; reduce intraoperative infusion of antibiotics and hypertonic fluids; avoid repeated puncture of the same vein; reduce the operating time; avoid infusion of large amounts of cryogenic fluids and stock blood; reduce the application of hemostatic drugs; and exercise early after surgery.
(ii) Physical prophylaxis
This measure is mainly applied to DVT prevention in patients with high bleeding risk or already bleeding.
1.Intermittent pneumatic compression (IPC) IPC helps to prevent thrombosis by repeatedly inflating and deflating the multi-lumen balloon and squeezing the limb from distal to proximal end in a uniform and orderly manner to accelerate venous and lymphatic return and improve microcirculation.
2.Graduated compression socks (GCS) GCS has a pressure gradient, that is, the pressure is gradually reduced from the foot upward, which effectively promotes the venous blood return of the lower limbs and prevents the occurrence of deep vein thrombosis in the lower limbs.
(iii) Pharmacological prophylaxis
For patients at high risk of VTE with low risk of bleeding, pharmacological prophylaxis can be taken according to the patient’s VTE risk classification, etiology, weight and renal function.
1.General heparin Activated partial thromboplastin time and platelet count should be monitored regularly.
2.Low molecular heparin High bioavailability; less serious bleeding complications; no need for routine monitoring.
3.Factor Xa inhibitors There are indirect factor Xa inhibitors (such as sulforaphane sodium) and direct factor Xa inhibitors (such as rivaroxaban); coagulation routine monitoring and dose adjustment are not required.
4. Vitamin K antagonists have a narrow therapeutic window, require routine monitoring of the international standardized ratio, and are susceptible to many drugs and foods.
II. VTE prevention strategies for in-hospital patients
Numerous guidelines recommend individualized prevention programs based on dynamic assessment of venous thromboembolism and bleeding risk in each hospitalized patient.
(A) Risk assessment for venous thromboembolism
The CapriniVTE risk assessment scale (see Table 1) is an individualized assessment scale, the validity of which has been demonstrated in relevant Western validation studies. The scale is scored according to a series of congenital and/or acquired risk factors and is classified as low risk (0-1), intermediate risk (2), high risk (3-4), and very high risk (≥5).
Early identification and management of bleeding complications
(A) Early identification
One or more of the following conditions is considered a major bleeding event: decrease in hemoglobin by at least 2Og/L; transfusion of at least 2U (red blood cell suspension or whole blood) to correct blood loss; retroperitoneal, intracranial, intralesional, intrapericardial or fundus bleeding; leading to serious or fatal clinical consequences (such as organ failure, shock or death); requiring medical resuscitation or surgical hemostasis.
(II) Prompt treatment
Identify the cause and site of bleeding and the patient’s coagulation status; delay anticoagulant administration or discontinue drug therapy; apply appropriate antagonistic drugs, such as fisetin, vitamin K; general hemostatic drugs; transfuse fresh plasma, plasminogen concentrate or perform plasma exchange; local pressure bandaging or surgical intervention.
In conclusion, pulmonary thromboembolism due to lower extremity deep vein thrombosis is an important cause of unintended death in hospitals and has become a serious problem for hospital administrators and clinical medical staff, therefore, medical and nursing staff at all levels pay enough attention to carry out VTE prevention scientifically and effectively, which has far-reaching significance to prevent medical risks, reduce medical costs and improve medical quality.