Prevention of Deep Vein Thrombosis in Trauma Patients in Critical Care Medical Centers and Certified Training Hospitals in Japan: Questionnaire Results
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Abstract:
肺血栓塞栓症(PTE)は従来本邦では頻度が少ないと思われていたが,生活様式の欧米化によってその頻度が増える傾向にある。2002年に示されたEAST (Eastern Association for the Surgery of Trauma)治療ガイドラインワークグループによる外傷患者における静脈血栓塞栓症(VTE)予防のための治療ガイドラインでは頭部外傷患者を除く出血のリスクが許容できるハイリスクのすべての外傷患者に低分子ヘパリン(LMWH)の使用を強く考慮すべきとしている。本邦における外傷患者に対するVTE予防法の現状を知るために,全国の救命救急センター及び救急指導施設に対してアンケート調査を行った。対象は全国の救命救急センターおよび日本救急医学会指導医指定施設(175施設)で,調査内容はVTEの経験の有無,基準を設けたVTE予防の有無,その基準と予防法とした。有効回答率は39%。回答施設の内,VTEの経験があったのは57.4%。基準を設けたVTE予防法を行っていたのは44.1%,行っていなかったのが55.9%であった。VTE予防を行っていたのは,VTEの未経験施設のうち37.5%, VTEの経験施設のうち47.1%であった。ハイリスクグループの基準として挙げられているのは床上安静例(体位交換禁止)が82.1%,筋弛緩剤使用下の人工呼吸例が64.3%,下肢牽引例が53.6%。 VTE予防法としてはfoot pumpが最も多く75%で,次にヘパリンの使用25%であった。LMWHの使用は極めて少なかった。近年,本邦でもVTEの予防指針案が作成されているが,救命救急センターや日本救急医学会指導医指定施設においてもDVT/PTE予防の認識が不十分であった。骨盤骨折や多発外傷の患者はVTEの高リスクであり,積極的に抗凝固療法に取り組むべきである。LMWHをはじめとした抗凝固薬の使用を含めたガイドライン策定によるVTE予防策の普及啓発が必要と思われた。Twenty-two patients who had an acute episode of thrombosis in the deep veins of the legs were studied by a new technique of ascending functional cinephlebography 6 to 12 months after the episode of thrombosis.If the condition was diagnosed within 36 hours and the thrombus was dissolved rapidly valve function was preserved. When diagnosis was delayed there was a very great risk of permanent damage to the valves.
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The upper extremity deep vein thrombosis rate is increasing at the same time that the rate for insertions of peripherally inserted central catheters is on the rise. There is little information on whether the established risk factors for lower extremity deep vein thromboses are effective to predict the occurrence of upper extremity deep vein thrombosis. The purpose of this study was to identify patients at highest risk for upper extremity deep vein thrombosis in order to initiate effective prophylaxis. A retrospective review was undertaken of medical records of all patients with peripherally inserted central catheters inserted in a 6-month period at a Midwestern US hospital. Of the 233 charts reviewed, 17 (7.3%) recorded an upper extremity deep vein thrombosis during the patient's hospital stay. Of the multiple factors identified with deep vein thrombosis in the literature, a weighted risk factor measure, the upper extremity deep vein thrombosis prediction tool, was developed. Sensitivity of the instrument for upper extremity deep vein thrombosis is high (88%), as are its specificity (82%) and negative predictive value (99%), whereas the positive predictive value is low (28%). The total percentage of cases correctly classified is 82%. Further testing is indicated on a larger sample to extend the validity of this instrument.
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Compression sonography in patients with indeterminate or low-probability lung scans: lack of usefulness in the absence of both symptoms of deep-vein thrombosis and thromboembolic risk factors.M P Rosen, R G Sheiman, J Weintraub and C McArdleAudio Available | Share
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Isolated calf vein thrombosis in the population of patients with deep vein thrombosis is found approximately in 10 to 25 % of cases. We present 3 cases of calf vein thrombosis which occurred due to unusual causes. Specific characteristics of this form of thromboembolic disease are discussed and compared to proximal deep vein thrombosis with emphasis to symptoms, risk of complications, prognosis and therapeutic approach.
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To find out the frequency of deep vein thrombosis in hip fracture patients.
Hip Fracture
Hip surgery
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In general medical patients presenting with suspected deep vein thrombosis routine use of x ray venography was associated with a large fall in the proportion of patients with a final diagnosis of deep vein thrombosis, from 83% to 25% (p less than 0.001), and with an appreciable shortening of hospital stay, from 13.6 to 7.2 days. The diagnosis of deep vein thrombosis was rejected in only 4% of patients when a venogram was not performed, and it is estimated that two patients were treated with anticoagulants unnecessarily for every patient treated correctly. The risk, expense, and inconvenience of unnecessary anticoagulant treatment far exceeds the risk, expense, and inconvenience of performing venograms routinely. The common practice of misdiagnosing deep vein thrombosis clinically should be abandoned.
Venography
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Objective To investigate how to prevent deep-vein thrombosis(DVT) after total knee replace-ment(TKR).Methods Deep vein thrombosis in 87 patients after TKR from 2004 to 2007 in the Third Hospital Affiliated to Suzhou University was retrospectively analyzed.Results Amony the 87 patients,13 were found having deep vein thrombosis,5 of 38 using low-molecular-weight beparin after TKR having deep vein thrombosis,6 of 35 cases using aspirin after TKR having deep vein thrombosis,5 of the 10 eases using mechanical preventive measures having deep vein thrombosis.The difference between low-molecular-weight heparin and aspirin group was not statistically significant.Conclusion Using low-molecular-weight heparin before TKR can prevent the occurrence of deep-vein thrombosis.Using epidural anesthesia,and a low-molee-ular-weight heparin drugs or aspirin after TKR can better prevent the formation of deep-vein thrombosis.
Key words:
total knee replacement; deep-vein thrombosis; prevention
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Deep vein thrombosis affects many hospitalized patients because of decreased activity and therapeutic equipment. This article reviews known risk factors for developing deep vein thrombosis, current prevention methods, and current evidence-based guidelines in order to raise nurses' awareness of early prevention methods in all hospitalized patients. Early prophylaxis can reduce patient risk of deep vein thrombosis and its complications.
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