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8/8/2019 Geriatric Board Copy 2_DVT Prophylaxis Elderly
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Celia Castellanos CruzTransitional Resident
Reference:Henny Billett, MDDirector, Thrombosis Prevention & TreatmentProgramProfessor of Clinical MedicineAlbert EinsteinCollege of Medicine
8/8/2019 Geriatric Board Copy 2_DVT Prophylaxis Elderly
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Why give prophylaxis?
Who should / should not get prophylaxis?
What products should we use?
What dose and for what duration?
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Thrombosis is a $1.5 billion/year potential problemThird leading cause of cardiovascular deathD irectives from the AACP 2008
Every hospital should develop a formal strategy that addresses VTE prevention (grade 1A)
Passive methods such as distribution of materials andeducational meetings not recommended as sole methods(grade 1B)
Joint Commission & CMSJOINT COMMISSION:
VTE ProphylaxisDay of or day after admission to hospital or ICUDischarge VTE discharge instructions
CMS NEVER EVENTS: (Preventable conditions for which CMS willnot make additional payment)
Last years entry: D VT or PE following TKR/THRSequelae of:
RecurrencePulmonary hypertensionPost-thrombotic syndrome
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* VTE at day 21
* VTE at day 21
VTE at day 21
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40-60% recentlydischarged
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Low Risk:For flights > 8 h (Grade 1C)
avoidance of constrictive clothingmaintenance of adequate hydrationfrequent calf muscle contraction.
High Risk:(Grade 2C)-
properly fitted, below-knee GC S (15-30mm Hg)Or a single prophylactic dose of LMWH on departure
For long-distance travelersthey recommend against the use of aspirin forVTE prevention (Grade 1B).
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H igh Risk Surgery T H R, TKR, HF SSpinal Cord Injury Trauma
Prolonged procedures
H igh Risk MedicalCHF
Severe respiratory diseaseConfined to bed with risk factors
Previous VTE Sepsis
Acute neurologic diseaseIBD
H ospitalized cancer patient
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They recommend against the use of aspirinalone as thromboprophylaxis against VTE forany patient group (Grade 1A).
For long-distance travelers, we recommendagainst the use of aspirin for VTE prevention
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Methods:Graduated compression stockingsIntermittent pneumatic compressionVenous foot pump
Mechanical methods of thromboprophylaxisshould be used primarily for patients at highbleeding risk (Grade 1A)Or possibly as an adjunct to anticoagulantthromboprophylaxis (Grade 2A).
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Why give prophylaxis? Its good for the patient, for the hospital/nursing home
Who should get prophylaxis?
Every inpatient in the geriatric population except those for whomthere is a contraindicationNursing home patients, just discharged patients, immobilized patients
With what? Not aspirin or mechanicals aloneU FH vs LMW H vs F ondaparinux
What dose/duration? H igher risk thrombosis/higher dose of AC if no contraindications
As long as the risk is high?