Venous Thromboembolism Prevention Clinical Care Standard
VenousThromboembolismPreventionClinical Care StandardJanuary 2020
Published by the Australian Commission on Safety and Quality in Health CareLevel 5, 255 Elizabeth Street, Sydney NSW 2000Phone: (02) 9126 3600Fax: (02) 9126 3613Email: mail@safetyandquality.gov.auWebsite: www.safetyandquality.gov.auISBN: 978-1-925665-57-4 Australian Commission on Safety and Quality in Health Care 2018All material and work produced by the Australian Commission on Safety and Quality in Health Care is protected by copyright.The Commission reserves the right to set out the terms and conditions for the use of such material.As far as practicable, material for which the copyright is owned by a third party will be clearly labelled. The Australian Commissionon Safety and Quality in Health Care has made all reasonable efforts to ensure that this material has been reproduced in thispublication with the full consent of the copyright owners.With the exception of any material protected by a trademark, any content provided by third parties, and where otherwise noted,all material presented in this publication is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0International licence.Enquiries about the licence and any use of this publication are welcome and can be sent tocommunications@safetyandquality.gov.au.The Commission’s preference is that you attribute this publication (and any material sourced from it) using the following citation: Australian Commission on Safety and Quality in Health Care. Venous Thromboembolism Prevention Clinical Care Standard.Sydney: ACSQHC; 2020First released 2018. Updated (minor revisions) January 2020.DisclaimerThe Australian Commission on Safety and Quality in Health Care has produced this clinical care standard to support the deliveryof appropriate care for a defined condition. The clinical care standard is based on the best evidence available at the time ofdevelopment. Healthcare professionals are advised to use clinical discretion and consideration of the circumstances of theindividual patient, in consultation with the patient and/or their carer or guardian, when applying information contained within theclinical care standard. Consumers should use the clinical care standard as a guide to inform discussions with their healthcareprofessionals about the applicability of the clinical care standard to their individual condition.Please note that there is the potential for minor revisions of this document.Please check www.safetyandquality.gov.au for any amendments.The Commission does not accept any legal liability for any injury, loss or damage incurred by the use of, or reliance on,this document.
ContentsVenous Thromboembolism Prevention Clinical Care Standard. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2About the clinical care standards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4General principles of care in relation to this clinical care standard . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Using this clinical care standard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Quality statement 1 – Assess and document VTE risk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Quality statement 2 – Develop a VTE prevention plan, balancing the risk of VTE against bleeding.16Quality statement 3 – Inform and partner with patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Quality statement 4 – Document and communicate the VTE prevention plan. . . . . . . . . . . . . . . . . . 23Quality statement 5 – Use appropriate VTE prevention methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Quality statement 6 – Reassess risk and monitor the patient for VTE-related complications . . . . . 28Quality statement 7 – Transition from hospital and ongoing care. . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Appendix 1: Medicines that affect bleeding risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Appendix 2: VTE prevention medicines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Acknowledgements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Venous Thromboembolism Prevention Clinical Care Standard, January 20201
Venous Thromboembolism PreventionClinical Care Standard21Assess and document VTE risk.A patient potentially at risk of venous thromboembolism (VTE) (as determined by local hospital/unit policy) receives a timely assessment of VTE risk using a locally endorsed evidence-basedtool to determine their need for VTE prevention. The result is documented at the time of theassessment, in a place that is easily accessible to all clinicians involved in the patient’s care.2Develop a VTE prevention plan, balancing the risk of VTE against bleeding.A patient assessed to be at risk of VTE has a prevention plan developed thatbalances the risk of thrombosis against the risk and consequences of bleeding (asan adverse effect of VTE prevention medicines). Other contraindications to VTEprevention methods are also considered before offering any to the patient.3Inform and partner with patients.A patient at risk of VTE receives information and education aboutVTE and ways to prevent it tailored to their risk and needs, andshares in decisions regarding their VTE prevention plan.4Document and communicate the VTE prevention plan.A patient’s VTE prevention plan is documented andcommunicated to all clinicians involved in their care.5Use appropriate VTE prevention methods.A patient requiring a VTE prevention plan is offered medicines and/or mechanicalmethods of VTE prevention according to a current, locally endorsed, evidence-basedguideline, taking into consideration the patient’s clinical condition and their preferences.6Reassess risk and monitor the patient for VTE-related complications.During hospitalisation, a patient’s thrombosis and bleeding risk is reassessed anddocumented at intervals no longer than every seven days, whenever the patient’sclinical condition or goals of care change, and on discharge from hospital. The patientis also monitored for VTE-related complications each time risk is reassessed.7Transition from hospital and ongoing care.A patient at risk of VTE following hospitalisation receives a written discharge plan orcare plan before they leave hospital, which describes their ongoing, individualisedcare to prevent VTE following discharge. The plan is discussed with the patientbefore they leave hospital to ensure they understand the recommended care andfollow-up that may be required. The plan is also communicated to the patient’sgeneral practitioner or ongoing clinical provider within 48 hours of discharge so thatongoing care to prevent VTE can be completed in accordance with the plan.Australian Commission on Safety and Quality in Health Care Clinical Care Standards
About the clinical care standardsClinical care standards aim to support the deliveryof appropriate evidence-based clinical care, andpromote shared decision making between patients,carers and clinicians.A clinical care standard contains a small numberof quality statements that describe the clinicalcare a patient should be offered for a specificclinical condition. Many of the quality statementsare linked to indicators that can be used by healthservice organisations to monitor how well they areimplementing the care recommended in the clinicalcare standard.A clinical care standard differs from, and is thereforenot intended to be, a clinical practice guideline.Rather than describing all the components of carerecommended for managing a clinical condition,a clinical care standard addresses priority areasof the patient pathway where the need for qualityimprovement is greatest.Clinicians are advised to use clinical judgementand consider an individual patient’s circumstances,in consultation with the patient and/or theircarer or guardian, when applying the informationin the clinical care standard. Health serviceorganisations are also responsible for ensuringlocal policies, processes, and protocols to guideclinical practice are in place, so that clinicianscan apply the information described in the clinicalcare standard and to enable clinicians and healthservice organisations to monitor the delivery ofappropriate care.Clinical care standards intend to support keygroups of people in the healthcare system by: Educating the public about the care that shouldbe offered by the healthcare system, and helpingthem to make informed treatment decisions inpartnership with their clinicians Providing clear information to clinicians to assistmaking decisions about appropriate care Outlining the systems required by healthservice organisations so that they are betterable to examine their performance and makeimprovements in the care that they provide.This Venous Thromboembolism Prevention ClinicalCare Standard was developed by the AustralianCommission on Safety and Quality in Health Care(the Commission) in collaboration with consumers,clinicians, researchers and health serviceorganisations. It complements existing efforts,including state and territory-based initiatives,which support the prevention of hospital-acquiredvenous thromboembolism (HA-VTE) in hospital andfollow‑up care in the community.For more information about the development ofthis clinical care standard visitwww.safetyandquality.gov.au/ccs.Updates in 2020The Venous Thromboembolism Prevention ClinicalCare Standard was updated in January 2020.Amendments include a review and update of thehyper-links throughout the document, and guidanceregarding dosing of medicines used to help preventVTE in obese people (Quality statements 1 and 5).Venous Thromboembolism Prevention Clinical Care Standard, January 20203
IntroductionContextVenous thromboembolism (VTE) is a potentiallypreventable disease that includes deep veinthrombosis (DVT) and pulmonary embolism(PE). It can result in complications suchas post‑thrombotic syndrome, pulmonaryhypertension, recurrent thrombosis, or death.In DVT a blood clot usually forms in the deepveins of the calf, thigh, or pelvis which may ormay not cause symptoms such as swelling,redness or pain. In some people, clots resolvespontaneously, however there is a risk that someor all of the clot may break away and travel to thelungs, resulting in PE. This can cause respiratorysymptoms, heart failure or death.Anyone can develop VTE and many risk factorshave been identified.2–11 Hospitalisation is a majorrisk factor with bed rest, dehydration, and vascularinjury from surgery or trauma contributing to this.About 50%–75% of people admitted to hospitalhave at least one other risk factor for VTE, while40% have three or more.2,12 Hospitalised patientsare more likely to develop VTE during or shortlyafter their hospital stay compared to those in thecommunity.13 Community studies of incidence andmodelling of health care statistics have shown thatup to 75% of all VTE in both medical and surgicalpatients occur as a result of hospitalisation, andup to half are not diagnosed until days, weeks, orin some instances, up to three months followingdischarge from hospital.13–15While the precise number of people affectedeach year is unknown, estimates suggest thatsymptomatic VTE affects about 1 per 1,000Australians per year.16,17 It is estimated to be oneof the leading preventable causes of death inhospital18,19, with modelling of healthcare statisticsshowing that PE accounts for 7% of all deathsin Australian hospitals every year.20,21 In almost25% of people affected, sudden death is the firstclinical sign of PE.14,224Death resulting from VTE acquired in hospital(also referred to as hospital-acquired VTE) isconsidered potentially preventable if effective VTEprevention methods during and after hospitalisationare in place.23 Currently this is the only approachlikely to reduce deaths from PE and diseaseburden from VTE. In fact, appropriate use ofVTE prevention methods is ranked as the topintervention hospitals can make to improve patientsafety 24,25, and international statistics suggest anational approach can reduce the rate of VTE,VTE‑related admissions, and VTE-related mortalityof hospitalised patients.26Randomised trials show VTE prevention methods(typically risk assessment followed by appropriateinitiation of pharmacological and/or mechanicalmethods), reduce development of symptomaticVTE by 55% to 70% in a broad range of medical orsurgical patients.4,5,8,27,28 It is well known that thesemethods differ in their balance of effectivenessand safety, depending on a patient’s health andtheir surgical or medical condition. The method ofprevention chosen needs to reflect this balance andrespect a patient’s wishes.Nevertheless, despite the availability of internationalevidence-based best-practice guidelines forthe prevention of VTE, data from Australia andinternationally suggest that a significant proportionof patients at risk of VTE do not receive care asrecommended in current guidelines.29–31In a recent Australian report, only 44%of surveyed clinical units reportedassessing patients for VTE risk onadmission to hospital using a standardisedrisk‑assessment tool. Furthermore only 74%of those assessed to be at risk were offeredVTE prevention based on the results of theirrisk assessment.1This gap between guideline recommendationsand practice has prompted multiple calls to actionto increase awareness about hospital-acquiredVTE.23,32–34 There is an urgent need to develop andimplement service wide policies to guide cliniciansin the systematic identification of patients at riskof VTE and the provision of appropriate VTEprevention, to reduce the burden of this condition.Australian Commission on Safety and Quality in Health Care Clinical Care Standards
Why this clinical carestandard is neededThis clinical care standard aims to support cliniciansand health services implement the delivery of highquality care to prevent VTE acquired in hospitaland following hospital discharge, by ensuring thatpatients who present to hospital with risk factors fordeveloping VTE: Are identified using a timely VTE risk assessment Are assessed for bleeding risk Have these risks formally documented as perlocal hospital/unit policy Are informed about VTE and share in decisionsabout their care and ways to prevent VTEKey evidence sources that underpin the VenousThromboembolism Prevention Clinical CareStandard are current clinical guidelines from theUnited Kingdom’s National Institute for Healthand Care Excellence (NICE) 27,35, the ScottishIntercollegiate Guidelines Network (SIGN)10, theAmerican College of Chest Physicians (ACCP) 4,5,8,36,the American Academy of Orthopaedic Surgeons(AAOS) 37, the American College of Physicians(ACP) 38, and the Royal College of Obstetrics andGynaecology (RCOG).39 Other resources includethe Agency for Healthcare Research and Quality(AHRQ) Quality Improvement Guide 34, and theVTE prevention framework developed by the NSWClinical Excellence Commission (CEC).33 Are prescribed appropriate VTEprevention methodsOther guidelines to assist clinical decision-makingand development of local hospital/unit policyinclude, but are not limited to: Have their VTE risk regularly reviewed whilein hospital Stroke Foundation: Clinical guidelines forstroke management (2017) 40 Have their VTE risk and VTE prevention plancommunicated to their ongoing clinical providerfollowing discharge from hospital. Arthroplasty Society of Australia:VTE guidelines for hip and kneearthroplasty (2018) 41 Therapeutic Guidelines: Cardiovascular(2012) 42Evidence sources thatunderpin this clinicalcare standard European guidelines on perioperative venousthromboembolism prophylaxis (2017) 43Note: As there is no current Australianclinical practice guideline for the preventionof VTE acquired in hospital, the VenousThromboembolism Prevention ClinicalCare Standard provides informationfrom international guidelines and otherhigh‑quality sources to support clinicaldecision-making and local development ofevidence-based policies and procedures.It is not intended to be a clinicalpractice guideline.Goal of this clinicalcare standardTo reduce avoidable death or disability causedby hospital-acquired VTE through improvedidentification of patients who are at risk,assessment of VTE and bleeding risk, andappropriate use of VTE prevention methods.Patients should also receive information about VTEand the risks and benefits of prevention so theycan share in decisions with their clinicians both inand out of hospital about their care and ways toprevent VTE.Venous Thromboembolism Prevention Clinical Care Standard, January 20205
Scope of this clinicalcare standardPatientsThe Venous Thromboembolism Prevention ClinicalCare Standard relates to the care that patients aged18 years and over should receive to reduce theirrisk of developing hospital-acquired VTE both inhospital and following discharge. It applies to thosewho are: Admitted to a hospital ward or unit within thepreceding 24 hours 44 Admitted to a day procedure service withsignificantly reduced mobility compared to theirnormal state, or require prolonged anaesthesia,or have multiple risk factors for developing VTE44 Discharged home from the emergencydepartment with significantly reduced mobilitycompared to their normal state (for example, dueto a lower-limb injury requiring immobilisationwith a plaster cast/brace) 44 Pregnant or have given birth within thepreceding six weeks, and present to outpatientservices for antenatal or perinatal care.Pathway of careThis clinical care standard covers the initialpresentation to hospital and assessment of VTErisk, through to completion of VTE prevention,which may occur following discharge from hospitalback in the community depending on the patient’songoing risk.Healthcare settingsThe following healthcare settings apply: All hospital settings where patients are atrisk of developing VTE, including public andprivate hospitals, day procedure services,and sub‑acute facilities such as rehabilitation,palliative care, and mental health units General practice and other community settingswhere ongoing monitoring and reassessmentof VTE risk are required to prevent VTEfollowing hospitalisation.Prevention strategiesThis clinical care standard covers the use ofpharmacological and mechanical methods ofVTE prevention.What is not coveredThis clinical care standard does not cover the useof inferior vena cava (IVC) filters to prevent VTE.Patients requiring these devices should be referredto an appropriate specialist for management.The diagnosis and treatment of VTE are alsooutside the scope of this clinical care standard.6Australian Commission on Safety and Quality in Health Care Clinical Care Standards
General principles of care in relationto this clinical care standardPatient-centred careCarers and family membersPatient-centred care is health care that is respectfulof, and responsive to, the preferences, needs andvalues of patients and consumers.45Carers and family members have an important rolein the prevention, early recognition, assessmentand recovery relating to a patient’s health condition.They often know the patient very well and canprovide detailed information about the patient’shistory, routines or symptoms, which may assist indetermining treatment and ongoing support.45Clinical care standards support the key principles ofpatient-centred care, namely: Treating patients with dignity and respect Encouraging patient participation indecision‑making Communicating with patients about their clinicalcondition and treatment options Providing patients with information in a formatthat they understand so they can participate indecision-making.46Although this clinical care standard does notspecifically refer to carers and family members,each quality statement should be understood tomean that carers and family members are involvedin clinicians’ discussions with patients about theircare, if the patient prefers carer involvement.Multidisciplinary careDuring a hospital admission and following dischargefrom hospital, patients are likely to need specifictypes of care provided by various clinicians.In this document, the term “clinician” refers toall types of health professionals who providedirect clinical care to patients. Multidisciplinarycare refers to comprehensive care providedby a range of clinicians (for example, doctors,nurses, pharmacists, physiotherapists and otherallied health professionals) from one or moreorganisations, who work collectively with the aim ofaddressing as many of a patient’s health and otherneeds as possible.47A coordinated multidisciplinary team approachis essential for delivering the care required toreduce the risk of VTE. Multidisciplinary careof patients can improve health outcomes, andoffers more efficient use of health resources.Planning, coordination and regular communicationbetween clinicians are essential components ofmultidisciplinary care.47Venous Thromboembolism Prevention Clinical Care Standard, January 20207
Using this clinical care standardIntegrated approachCentral to the delivery of patient-centred careidentified in this clinical care standard is anintegrated, systems-based approach supportedby health services and networks of services withresources, policies, processes and procedures.Key elements of this approach include: An understanding of the capacity andlimitations of each component of the healthcaresystem across metropolitan, regional andremote settings Clear lines of communication betweencomponents of the healthcare system,including primary care, hospital, sub-acute,and community services Appropriate coordination so that people receivetimely access to optimal care regardless of howor where they enter the system.To achieve these aims, health service organisationsimplementing this standard may need to: Deploy an active implementation plan andfeedback mechanisms Include agreed protocols and guidelines,decision-support tools and otherresource material Employ a range of incentives and sanctions toinfluence behaviours and encourage compliancewith policy, protocol, regulation and procedures Integrate risk management, governance,operational processes and procedures, includingeducation, training and orientation.48To assist health service organisationsimplement the Venous ThromboembolismPrevention Clinical Care Standard, keyconsiderations for clinical decision‑makingand local policy development havebeen included under some of thequality statements.8Integration with the NationalSafety and Quality HealthService (NSQHS) StandardsThe National Safety and Quality Health Service(NSQHS) Standards were developed by theCommission in collaboration with the Australiangovernment, states and territories, clinical experts,and consumers. The primary aims of the NSQHSStandards are to protect the public from harm andimprove the quality of health service provision. Theyprovide a quality assurance mechanism that testswhether relevant systems are in place to ensureexpected standards of safety and quality are met.The first edition of the NSQHS Standards, whichwas released in 2011, has been used to assesshealth service organisations since January 2013.The second edition of the NSQHS Standards waslaunched in November 2017, and health serviceorganisations will be assessed against the newstandards from January 2019.In the second edition of the NSQHS Standards,the Clinical Governance Standard and Partneringwith Consumers Standard combine to formthe clinical governance framework for all healthservice organisations.The Clinical Governance Standard aims to ensurethat there are systems in place within health serviceorganisations to maintain and improve the reliability,safety and quality of health care.The Partnering with Consumers Standard aims toensure that consumers are partners in the design,delivery and evaluation of healthcare systems andservices, and that patients are given the opportunityto be partners in their own care.Under the NSQHS Standards (2nd ed.), healthservice organisations are expected to supportclinicians to use the best available evidence,including clinical care standards such as theVenous Thromboembolism Prevention Clinical CareStandard where relevant (see Action 1.27b).Australian Commission on Safety and Quality in Health Care Clinical Care Standards
Health service organisations are expected to implement the NSQHS Standards in a manner that suits theclinical services provided and their associated risks. Other aspects of the NSQHS Standards (2nd ed.) thatare particularly relevant to the prevention of hospital-acquired VTE include, but are not limited to, those listedin the following ingfor SafetyStandard:Governance,leadershipand culture(1.1 and 1.2)Informed consent(2.3, 2.4 and 2.5)Clinical governanceand qualityimprovement tosupport medicationmanagement(4.1 to 4.4)Communication ofcritical information(6.9)Safety and qualitymonitoring,including incidentreporting systems(1.8, 1.11)Sharing decisionsand planning care(2.6 and 2.7)Documentation ofpatient information(4.5 to 4.9)Documentation ofinformation (6.11)Policies andprocedures (1.7)Informationfor consumers(2.9) andcommunicationof clinicalinformation (2.10)Continuity ofmedicationmanagement(4.10 to 4.12)Credentialingand scope ofclinical practice(1.23 and 1.24)RecognisingandRespondingto AcuteDeteriorationStandard:Responding todeterioration (8.10)Managementof high riskmedicines (4.15)Evidence-basedcare (1.27)Variation inclinical practiceand healthoutcomes (1.28)Venous Thromboembolism Prevention Clinical Care Standard, January 20209
Indicators to supportlocal monitoringThe Commission has developed a set of indicatorsto support healthcare providers and local healthservice organisations to monitor how well theyimplement the care described in this clinical carestandard. The indicators are a tool to support localquality improvement activities. No benchmarks areset for any indicator.The process to develop the indicators specified inthis document comprised: A review of existing local andinternational indicators Prioritisation, review and refinement of theindicators with the Venous ThromboembolismClinical Care Standard Topic Working Group.Most of the data underlying these indicators requirecollection from local sources, mainly throughprospective data collection or a retrospectivechart review. Where an indicator refers to ‘localarrangements’, this can include clinical guidelines,policies, protocols, care pathways or any otherdocumentation providing guidance to clinicians onthe care of patients to prevent hospital-acquiredVTE, both in hospital and following dischargefrom hospital.10METeOR is Australia’s web-based repositoryfor national metadata standards for the health,community services and housing assistancesectors. Hosted by the Australian Institute of Healthand Welfare, METeOR provides users with onlineaccess to a wide range of nationally endorsed dataand indicator definitions.Indicators to support localmonitoring of the overallquality of VTE preventionAs the goal of this clinical care standard is toreduce the burden of hospital-acquired VTEboth in hospital and following hospital discharge,three overall outcome measures are alsorecommended. Data on hospital-acquired DVT andPE and haemorrhagic disorder due to circulatinganticoagulants are now collected routinely as partof the Hospital Acquired Complications (HACs) listand can assist hospitals in tracking the successof their efforts to prevent VTE. The specificationsfor these indicators can be found icators/hospital-acquired-complications/Outcome indicator 1:Rate of hospital-acquired deep vein thrombosisMonitoring the implementation of the clinicalcare standards will assist in meeting some of therequirements of the National Safety and QualityHealth Service (NSQHS) Standards. Informationabout the NSQHS Standards is available ndardsOutcome indicator 2:Rate of hospital-acquired pulmonary embolismIn this document, the indicator titles andhyperlinks to the specifications are included withthe relevant quality statement under the heading‘Indicators for local monitoring’. Full specificationsof the Venous Thromboembolism PreventionClinical Care Standard indicators can be found inthe Metadata Online Registry (METeOR) emId/697224The Commission’s website has more informationabout the HACs list and the indicator specifications.Outcome indicator 3:Rate of haemorrhagic disorder due to circulatinganticoagulantsAustralian Commission on Safety and Quality in Health Care Clinical Care Standards
Measuring and monitoringpatient experienceSystematic routine monitoring of patients’experiences of healthcare is an importantway to ensure that service improvements andpatient‑centeredness are driven by patients’perspectives. This is the case with all healthservices, including the prevention of VTE.While there are no indicators in this standardspecific to patient experience measurement, theCommission strongly encourages health servicesto adopt the Australian Hospit
implementing the care recommended in the clinical care standard. A clinical care standard differs from, and is therefore not intended to be, a clinical practice guideline. Rather than describing all the components of care recommended for managing a clinical condition, a clinical care standard addresses priority areas
Clinical Case Studies in Venous Thromboembolism: Using Direct Oral Anticoagulants for Treatment and Secondary Prevention Activity Overview Clinical case studies will be used to illustrate the decision-making process regarding the acute treatment and secondary prevention of venous thromboembolism (VTE) based on recently updated guidelines and
The VICI VENOUS STENT System has been sterilized with ethylene oxide. Contents One (1) VICI VENOUS STENT Delivery System INTENDED USE The VICI VENOUS STENT is intended for the treatment of obstructions and occlusions in the venous vasculature. INDICATIONS FOR USE The VICI VENOUS STENT System is indicated for improving luminal diameter
Table 28: VTE prophylaxis in bariatric surgery .47 . 6 . Introduction Venous thromboembolism (VTE), a disease which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE) is a major health-care problem
Pediatric venous thromboembolism (VTE) is a life-threatening condition associated with increased . It is increasingly being recognized as a complication of contemporary health care in the pediatric population. 2. Estimated annual incidence among hospitalized pediatric patients is upwards of 60 events per 10,000 admissions. . (PICC). 3.2.3 .
Deep venous thrombosis and pulmonary embolism Medical Illustrator: Bill Garriott CCF 2011 Sitting for long periods during long flights can lead to venous stasis and deep venous thrombosis. Although the absolute risk is low, it is higher in those with preexisting risk factors for
Administration of pharmacological deep vein thrombosis prophylaxis within the first 72 hours post ABI may be effective for reducing the risk of developing deep vein thrombosis. Enoxaparin is effective for the prevention of Venous Thromboembolism development after elective neurosu
Comparative Effectiveness Review . Number 191 . Venous Thromboembolism Prophylaxis in Major Orthopedic Surgery: Systematic Review Update . Prepared for: Agency for Healthcare Research and Quality . U.S. Department of Health and Human Services . 5600 Fishers Lane . Rockville, MD 20857 . ww
The American Petroleum Institute (API) 617 style compressors are typically found in refinery and petrochemical applications. GE strongly recommends the continuous collection, trending and analysis of the radial vibration, axial position, and temperature data using a machinery management system such as System 1* software. Use of these tools will enhance the ability to diagnose problems and .
