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Archive September 2017 XVIII, No. 9

Deep Dive Into VTE Prevention

Match prophylaxis to patient-specific risks to guard against clot formation.

Christopher Pannucci

Christopher Pannucci, MD, MS, FAWM


patient-specific prophylaxis measures SAME-DAY SAFETY The importance of considering patient-specific prophylaxis measures is heightened as more complex procedures move to the outpatient setting.

It's not easy to tell which patients are at risk for developing life-threatening deep vein thrombosis (DVT) and pulmonary embolus (PE), known collectively as venous thromboembolism (VTE). Besides the fact that clotting risk factors aren't obvious, every patient has different risks for developing VTE, regardless of the type of surgery they're undergoing.

My go-to standard to gauge VTE risk is the Caprini Score Risk Assessment Model. The tool, which assesses the risk stratification of individual patients, takes into account not only the type and extent of the scheduled surgery, but also the patient's medical comorbidities, personal and family history of clots, and other recognized factors that help you identify clotting risk. The Caprini score guides you to ask the questions that can reveal a patient's true risk of VTE. The exhaustive list of questions lets providers create an aggregate risk factor score, which will help determine the preventative measures that would work best on a case-by-case basis.

High Caprini scores should prompt you to further assess patients to see how to modify and reduce their risk factors. Once you've identified risk factors, you need to stop, slow down and ask yourself if any of them are modifiable. For example:

  • Has a patient had a recent operation? Maybe you can wait longer than 30 days to perform an elective procedure to ensure risk from a prior anesthetic has resolved.
  • Does a cancer patient have a port inserted for the infusion of chemotherapy? Try to remove the port in advance of surgery to eliminate it as a potential thrombotic source.
  • Are young female patients on oral contraceptives, which are known to be associated with clots? Have them stop taking the pills 4 weeks before surgery, so the medications are metabolized long before they enter your ORs.

Clearly, consideration of VTE risk level at a pre-op visit, as opposed to in the pre-op holding area, may allow modification of identified risk factors.

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