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Patients undergoing major orthopedic surgery including hip and knee replacements are at particularly high risk for DVT.Prevention of Venous Thromboembolism in Surgical Patients. Giancarlo Agnelli, MD

Blood Clot and DVT FAQs

  1. How is a blood clot formed?
    A blood clot is the product of blood coagulation, which is the body’s response to an injury to help prevent bleeding, but can be harmful when clots obstruct blood flow through the veins. When a clot forms within a deep vein (usually in the legs or sometimes arms) it is referred to as a Deep Vein Thrombosis, or DVT.
  2. What is the difference between a blood clot and a DVT?
    When a clot forms within a deep vein (usually in the legs or sometimes arms) it is referred to as a Deep Vein Thrombosis, or DVT.
  3. What are the risks of DVT?
    DVT risk factors include (but are not limited to) age over 40, obesity, immobility, surgery, smoking, varicose veins, taking oral contraceptives, chemotherapy and recent stroke. People recovering from total hip or total knee surgeries are among the highest risk of DVT, and risk is greatest 5-10 days after surgery. To learn your risk, click here to take the self-evaluation.
  4. How can you prevent DVT?
    DVT prevention methods include taking anticoagulant medications as well as utilizing mechanical prophylaxis (compression sleeves connected to a DVT pump.) There are many potential drug interactions concerning anticoagulant medications, making mechanical prophylaxis a safe and effective prevention method. Patients may also be prescribed anticoagulant medications (blood thinners) in conjunction with mechanical prophylaxis based on their level of risk.
  5. What is the treatment for DVT?
    Taking blood thinners can help prevent a clot from growing and breaking off, causing a life-threatening Pulmonary Embolism. Heparin may be administered intravenously in the hospital, and then continued at home. However, they will not dissolve an existing clot. Your body may eventually dissolve the clot, however there are risks that the clot could damage the vein over time. Doctors may recommend a clot-busting drug, however the treatment is administered in the hospital and carries risk of bleeding problems and stroke.
  6. What are the warning signs of DVT?
    Warning signs include pain or tenderness in an extremity or groin, sudden swelling of the leg, warmness of the skin, and change of color in the leg. If you suspect you have a DVT, call your surgeon or healthcare provider immediately.

Pulmonary Embolism and VTE FAQs

  1. What causes a Pulmonary Embolism?
    A Pulmonary Embolism, or PE, occurs when one or more pulmonary arteries in your lungs become blocked. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from the legs or rarely other parts of the body (deep vein thrombosis, or DVT).
  2. What are the risks of Pulmonary Embolism?
    Risks of PE are similar to risks of DVT, since most PEs develop as a result of DVT. Such risks include (but are not limited to) family history, age over 40, obesity, immobility, surgery, smoking, varicose veins, taking oral contraceptives, chemotherapy and recent stroke.
  3. How is a PE treated?
    When a PE is life threatening, an emergency treatment called Thrombolytics can quickly dissolve the clot, however can cause sudden bleeding. In other scenarios, a catheter is inserted through the groin and up to the lung to deliver medicine to dissolve the clot. In some cases, surgery may be required.
  4. What is a VTE?
    When a DVT forms that causes a Pulmonary Embolism, this event is referred to as a VTE, or Venous Thromboembolism.
  5. What can you do to prevent a VTE?
    Preventing VTE begins with DVT prevention. DVT prevention includes taking anticoagulant medications as well as mechanical prophylaxis (compression sleeves used with a DVT pump.) There are many potential drug interactions concerning anticoagulant medications, making mechanical prophylaxis a safe and effective prevention method. Patients may also be prescribed anticoagulant medications in addition to mechanical prophylaxis based on their level of risk.

Compression Sleeves FAQs

  1. How are compression sleeves used?
    Compression sleeves are made of soft fabric and wrap around the calf. They are often used in conjunction with a mechanical pump to inflate the sleeves intermittently from bottom to top to simulate ambulation when someone is not active, or are at risk for DVT. The inflation squeezes the calves so that circulation is increased, keeping clots from forming
  2. What is the difference between compression sleeves and SCD sleeves?
    SCD sleeves are short for Sequential Compression Device sleeves. This more pointedly implies that the sleeves are used with a compression pump, not to be confused with compression socks or stockings, which are not inflated mechanically.
  3. How do compression sleeves help prevent DVT?
    Compression sleeves push blood from distal to proximal intermittently, which mimics ambulation (or moving about). This increase in blood flow keeps the blood from pooling (most often in the leg), causing it to clot.

Compression Device FAQs

  1. How is a compression device used?
    Compression devices are used in conjunction with calf, foot or leg sleeves to prevent DVT. Compression devices can also be used with orthotic joint wraps to reduce swelling at surgery or injury sites.
  2. What does a compression device look like?
    Compression devices come in a variety of sizes and weights. Hospital grade pumps are larger and usually hook onto the hospital bed. Take-home compression devices like the Triple Play VT are small enough to fit in one had and weigh less than a pound, making it convenient to use anywhere.
  3. How do compression devices help prevent DVT?
    Compression devices connect to calf sleeves and push blood from distal to proximal intermittently, which mimics ambulation (or moving about). This increase in blood flow keeps the blood from pooling (most often in the leg), causing it to clot.
  4. How do compression devices help with pain and swelling?
    Compression devices, when connected to joint orthotic wraps, pump air intermittently to squeeze out swelling from the affected site. When cold is combined with this compression it helps minimize pain as well.
  5. What is the difference between a "compression device" and a "DVT pump?"
    A DVT pump is a type of compression device. All DVT pumps are a type of compression device, but compression devices can also be used for purposes other than DVT prevention. A compression device can be used to help reduce pain and swelling for joint or muscle recovery.

DVT Prevention FAQs

  1. What is the best way to prevent DVT?
    DVT prevention methods include taking anticoagulant medications as well as utilizing mechanical prophylaxis (compression sleeves connected to a DVT pump.) There are many potential drug interactions concerning anticoagulant medications, making mechanical prophylaxis a safe and effective prevention method. Patients may also be prescribed anticoagulant medications in conjunction with mechanical prophylaxis based on their level of risk.
  2. When are you at the highest risk of DVT?
    People are at particularly high risk of DVT after surgery, (hip and knee surgeries being the highest). Risk is highest five to ten days following surgery, most likely when patients are recovering at home. This makes DVT prevention at home a vital part of patient care. Other risk factors of DVT include age over 40, obesity, immobility, surgery, smoking, varicose veins, taking oral contraceptives, chemotherapy and recent stroke.
  3. Why is it important to prevent DVT after leaving the hospital?
    Since risk of DVT is highest five to ten days following surgery, this is the period most patients are recovering at home.
  4. How does mechanical prophylaxis help prevent DVT?
    Compression devices connected to calf sleeves (referred to as “mechanical prophylaxis”) push blood from distal to proximal intermittently, which mimics ambulation (or moving about). This increase in blood flow keeps the blood from pooling (most often in the leg), causing it to clot.
  5. Should I use mechanical DVT prevention if I already have a DVT?
    Patients with a blood clot should not use mechanical DVT prevention. Please consult your physician.

Resources

AAOS Guidelines

ACCP Guidelines

Patients undergoing major orthopedic surgery including hip and knee replacements are at particularly high risk for DVT.

Prevention of Venous Thromboembolism in Surgical Patients. Giancarlo Agnelli, MD

DVT is the most common cause for hospital readmission after hip replacement.

Seagroatt V, Tan HS, Goldacre M, et al. Elective total hip replacement: incidence, emergency readmission rate, and postoperative mortality. BMJ. 1991; 303: 1431–1435

DVT peaks on the fifth postoperative day, and the vulnerability to DVT appears to last for three months. This reflects the belief of most orthopedic surgeons that prophylactic therapy should continue beyond the acute care facility until the patient is spending the majority of his day ambulating.

Fitzgerald RH Jr., Orthopedics. 1996 Aug; 19 Suppl: 15-8

DVT prevention has been at the forefront of orthopedic care for lower extremity arthroplasty, which is at high risk for DVT. Risk of bleeding increases in total hip arthroplasty with low-molecular-weight heparin (LMWH) prophylaxis. A mobile compression device (MCD) that allows patients to move freely in hospital and at home may be safer.

Hardwick ME, Pulido PA, Colwell CW Jr. Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA

Majority of DVTs develop 5-10 days following surgery.

Venous Thromboembolism Following Major Orthopedic Surgery: What is the Risk After Discharge? Juan I. Arcelus, MD, PhD, 1 James C. Kudrna, MD, PhD,2-4 and Joseph A. Caprini, MD, MS

Caprini Venous Thromboembolism Risk Factor Assessment

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