Thromboembolic Disease

A

Epidemiology

• 1.

  Deep vein thrombosis (DVT) and pulmonary embolism (PE) are two manifestations of venous thromboembolism (VTE). Despite advances in prevention and treatment of VTE, PE remains the most common preventable cause of hospital death, responsible for approximately 150,000–200,000 deaths per year in the United States.

  • a.

    Prevention begins before surgery by considering the surgical procedure, its risks, and the patient’s comorbidities.

  • b.

    The physician must consider the length of hospitalization, postoperative course, and the patient’s rehabilitation status.

B

Causative Factors

• 1.

  Multiple predisposing factors contribute to development of DVTs, and contributing are the characteristics found in Virchow triad:

  • a.

    Venous stasis—inactivity, cardiac factors (i.e., congestive heart failure), anesthesia induction

  • b.

    Endothelial injury—all operative procedures in which blood flow is interrupted

  • c.

    Hypercoagulability—medical conditions (cancer, pregnancy, inherited hematologic diseases)

C

Other Risk Factors for the Development of Deep Vein Thrombosis

• 1.

  Age older than 40 years

• 2.

  Malignancy

• 3.

  History of DVT or PE

• 4.

  Obesity

• 5.

  Major surgery

• 6.

  Trauma

• 7.

  Pregnancy

• 8.

  Oral contraceptives (hormonal therapy)

• 9.

  Physical inactivity

D

Clinical Presentation

Nonspecific and often detected only after PE has occurred

• 1.

  Signs include swelling, tenderness, calf pain elicited on passive dorsiflexion of the ankle (Homan sign), or fever.

  • a.

    Less than 50% of patients with DVTs will exhibit these signs.

E

Differential Diagnoses

• 1.

  Achilles tendonitis, arterial insufficiency, arthritis, cellulitis, lymphangitis, varicose veins, superficial thrombophlebitis, Baker cyst

F