Prevention of venous thromboembolism: focus on mechanical prophylaxis.
Summary of "Prevention of venous thromboembolism: focus on mechanical prophylaxis."
Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is a leading health-care problem whose pathogenesis is usually related to the so-called Virchow's triad and involves a variety of factors classified as inherited or acquired, predisposing, or triggers. The main goal of thromboprophylaxis is to reduce mortality and morbidity associated with VTE risk factors. Although striking evidence now indicates that the various pharmacological anticoagulant therapies can substantially lower the risk, this benefit might be offset by a small but definite risk of hemorrhage in some circumstances. Mechanical prophylaxis methods have been suggested because they counteract most of the components of the Virchow's triad and are not associated with any bleeding risk. Although early and frequent ambulation has been historically advised for preventing VTE, this measure is inadequate per se and frequently not feasible as the sole means of mechanical thromboprophylaxis. Accordingly, additional measures are being used in clinical practice, including graded compression stockings, intermittent pneumatic compression devices, and venous foot pumps. Although the efficiency of these measures has been extensively assessed in several clinical studies, there remain unanswered questions, including their suboptimal use and the lack of unequivocal clinical evidence supporting real benefits for preventing VTE. Overall, mechanical compression methods can reduce the risk of VTE by nearly two thirds when used as the only form of thromboprophylaxis and by about half when combined with a pharmacological approach. The main mechanism of action appears to be related to a milking (wavelike) effect to evacuate leg veins and reduce venous stasis because an effect on the enhancement of fibrinolysis remains unproven. Although the biological and clinical evidence suggests that graduate compression stockings are an effective, relatively cheap, and more comfortable thromboprophylactic measure, they appear less effective overall than intermittent pneumatic compression. In conclusion, although the preventive benefits of mechanical prophylaxis on VTE might be circumscribed to select medical and surgical settings, there appears to exist no clinical reason to discourage adoption of these measures when indicated.
U.O. di Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
This article was published in the following journal.
Name: Seminars in thrombosis and hemostasis
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21455858
- DOI: http://dx.doi.org/10.1055/s-0031-1273088
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Medical and Biotech [MESH] Definitions
An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide.
Impaired venous blood flow or venous return (venous stasis), usually caused by inadequate venous valves. Venous insufficiency often occurs in the legs, and is associated with EDEMA and sometimes with VENOUS STASIS ULCERS at the ankle.
Obstruction of a vein or VEINS (embolism) by a blood clot (THROMBUS) in the blood stream.
Instruments that generate intermittent forces, uniformed or graduated, to facilitate the emptying of VEINS. These devices are used to reduce limb EDEMA and prevent venous THROMBOEMBOLISM, such as deep vein thrombosis in the legs.
The prevention of infection or disease following exposure to a pathogen. This is most frequently addressed by administering a vaccine or anti-viral medication following exposure to a virus.