Venous thromboembolism is often encountered clinically, and once a pulmonary embolism occurs it is very dangerous, and many doctor-patient disputes are related to this disease. The factors of deep vein thrombosis boil down to three parts: blood hypercoagulation, slow blood flow, and damage to the vessel wall.
Many departments in the hospital are more or less involved in these three parts, which eventually lead to the formation of deep vein blood, bringing great inconvenience and risk to the hospital and patients. With the international clinical concern and attention to the prevention of deep vein thrombosis, more and more hospitals and departments begin to pay attention to the prevention of deep vein thrombosis in clinical practice, so which departments are more likely to suffer from deep vein thrombosis?
I. Orthopedics
Orthopedic surgery patients due to the following factors.
1, patients after fracture surgery, due to pain as well as being in passive position, resulting in muscle contraction dysfunction, which reduces the driving force of venous blood flow, slowing down the blood and stagnating it.
2. Preoperative fasting and postoperative blood and fluid loss can cause an increase in blood viscosity, which can lead to DVT formation.
Studies have shown that the incidence of DVT in postoperative orthopedic patients is 10%-80%, the incidence of PE is 15%-50%, and the incidence of fatal PE is 0,5% -5% ,and PE is the most common cause of death after hip fracture surgery.
Second, general surgery
Surgical patients due to the following factors.
1, long operation time, prolonged postoperative bed rest, and passive position can lead to slow blood flow or stasis;
2, preoperative fasting, intraoperative and postoperative blood loss, fluid loss and the use of hemostatic drugs can cause an increase in blood viscosity;
3, surgical trauma and postoperative venipuncture can also lead to o}rape pеDVT l birth.
Overseas, the incidence of DVT after major surgery without preventive measures is reported to be 25%; domestic reports, the incidence of DVT after general surgery is reported to be 19%, and the incidence of fatal PE caused by DVT is about 5,5%-20,8% in general surgery.
III. Oncology
Patients due to the following factors.
1. venous blood stasis due to prolonged bed rest, reduced activity or compression of blood vessels by huge masses.
2. tumor cells can directly activate coagulation pathways, induce the production of procoagulant substances, inhibit the anticoagulant activity of vascular endothelial cells, platelets and monocytes, resulting in blood in a hypercoagulable state.
3.The tumor cells are damaged when they invade the vessel wall, triggering the formation of DVT and the occurrence of PE in the lower limbs.
It is reported that 10-30% of DVT patients are tumor patients, and about 15% of the second tumor patients can have DVT.
IV. Gynecology
patients due to the following factors.
1, transvaginal surgery, pneumoperitoneum established by laparoscopic surgery will affect the venous blood return, further slowing down or stagnating the venous blood flow.
2, most gynecological surgeries are operated in the pelvis (dense pelvic veins, thin vein walls, and lack of extrafascial sheaths), which are more likely to lead to vascular injury during the operation.
3, the application of postoperative hemostatic drugs, shock, dehydration and other factors can cause the blood to be in a hypercoagulable state and trigger the formation of DVT.
According to the relevant literature, the incidence of DVT after gynecological surgery is 7%-45%, of which the incidence after gynecological pelvic surgery is as high as 30%-45%, and the incidence of death secondary to PE is as high as 25%.
V. Obstetrics
patients due to the following factors.
1, the blood volume of women during pregnancy increases by 20%-100%, and the enlarged uterine m during pregnancy can compress the veins of the abdominal cavity and pelvis, affecting the venous blood pressure reflux.
2, the increase in coagulation factors and fibrinogen in the blood of women during pregnancy blood, platelet aggregation, increased resistance to activated plasma protein C and other factors can lead to blood in a hypercoagulable state, vascular endothelial damage caused during cesarean delivery or vaginal delivery, which can easily induce the formation of DVT.
According to tW literature, the incidence of DVT in women during pregnancy is 0.76%-1.72%.
VI. Cardiothoracic surgery
Patients due to the following factors.
1, prolonged postoperative bed rest, etc. resulting in slowed venous blood flow;?
2.Anesthesia extracorporeal circulation and postoperative trauma leading to coagulation disorders and a hypercoagulable state of blood.
3, hematoma compression, surgical operation, trauma infection and other factors can lead to damage to the endothelium of the blood vessel
4, central venous placement leads to a decrease in venous pressure and flow rate, and the lumen of the vessel becomes narrow, promoting thrombosis.
According to tW literature, the incidence of DVT in large open-heart surgery is 50%-60%, and the incidence of PE is as high as 6 or 6% in the autopsy cases of postoperative death in cardiothoracic surgery, and according to foreign studies, the incidence of PE after open-heart surgery is as high as 20% and the lethality rate is 1%.
VII. Neurosurgery
patients due to the following factors.
1, neurosurgery patients are more comatose and unconscious, and this will cause muscle contraction dysfunction and loss of mobility in the limbs for a long time.
2.Surgical patients are bedridden for a long time due to the requirements of special positions, which can easily lead to blood stasis.
3. Surgery and trauma cause blood to be in a hypercoagulable state, which can easily induce the formation of thrombus.
According to the relevant literature, the incidence of DVT in neurosurgical patients after surgery is 19% to 50%, and the incidence of PE is 1.50% to 5.00%.
VIII. Neurology
patients due to the following factors.
1, the vast majority of neurology patients have limited limb movement, resulting in slow blood flow, and the patient has difficulty turning and is in a fixed position for a long time, and the blood vessels are under constant pressure resulting in sluggish blood flow;
2, preoperative clean enema and intraoperative massive blood and fluid loss, resulting in reduced effective circulating blood volume and blood stasis.
3, postoperative infection, hyperthermia, large aggregation of leukocytes and damage to the vessel wall prompting the release of thrombogenic substances from intradermal cells.
4. Continuous intravenous injection of highly irritating drugs requiring rapid infusion such as mannitol injections, the use of certain highly permeable liquid fat milks and damage to the venous wall caused by deep vein placement and peripheral venipuncture all predispose to the formation of DVT.
According to tW literature, the average incidence of DVT in stroke patients is 50%, most of which occurs in the paralyzed lower extremities, and about 25% of acute mortality in patients after stroke is caused by PE.
IX. Urology
patients due to the following factors.
1, patients with urological surgery, mostly in pelvic operations or transurethral lumpectomy, are prone to vascular wall injury.
2, long-term postoperative bed rest and the role of hemostatic drugs, shock, dehydration and other factors can lead to lower limb venous blood flow stagnation, blood in a hypercoagulable state, which is very likely to induce DVT.
X. Burn unit
Patients due to the following factors.
1, the patient’s limbs are in passive position for a long time, trauma and surgery lead to local limb swelling and complete loss of muscle contraction function, which in turn leads to stagnation of venous blood flow.
2.Burns or surgery (including other treatments such as intravenous cannulation) cause endothelial damage, initiate exogenous coagulation pathways, and promote thrombosis.
3, Shock, dehydration and other factors make the blood volume relatively insufficient, platelet aggregation increases, plasma protein S, and antithrombin decreases, which can lead into blood hypercoagulation state.
Burn patients should be a high-risk group for thromboembolism
The above are the departments where more patients with deep vein thrombosis occur clinically, and some other departments such as vascular surgery and respiratory department also have deep vein thrombosis. These departments are the key departments for prevention and care of DVT in clinical practice.
The vast majority of patients with DVT tend to develop in the left lower extremity because the left common iliac vein is often compressed by the right common iliac artery in the adult population (Cockett’s syndrome), especially in women, and clinicians should pay close attention to these patients.