You may have heard of such a thing, where a patient who had a successful surgery suddenly passed away. Why is that? With this question in mind, what is VTE? How should VTE be treated and prevented? Below, I will introduce the invisible assassin around us - VTE.
1、 What is VTE?
VTE stands for venous thromboembolism; It is a group of diseases in which blood clots abnormally in veins, causing complete or incomplete blockage of blood vessels. It includes deep vein thrombosis and pulmonary embolism, with high incidence rate and mortality.
The treatment methods for VTE include anticoagulation, thrombolysis, surgical thrombectomy, and placement of inferior vena cava filters.
Anticoagulants include injectable anticoagulants, traditional oral anticoagulants, and new oral anticoagulants:
injectable anticoagulants
(1) unfractionated heparin: may cause thrombocytopenia, and platelet count must be rechecked on the 3rd to 5th day of use;
(2) Low molecular weight heparin: generally does not require routine monitoring of coagulation indicators, and platelet count is measured when there is a tendency to bleed.
Oral anticoagulants
(1) Traditional oral anticoagulants, such as warfarin, are usually initially used in combination with unfractionated heparin or low molecular weight heparin sodium, and require routine monitoring of coagulation indicators INR (target range 2.0-3.0)
(2) New oral anticoagulants, such as rivaroxaban, are convenient to use orally and require routine monitoring of coagulation indicators.
Rest and Activity
During anticoagulant therapy, strictly lie in bed, raise the affected limb, and apply immobilization. Raise the affected limb by 15-30 degrees, slightly above the level of the heart, flex the knee joint by 15-20 degrees, avoid using a pillow under the knee, and keep the iliac vein in a relaxed state, which helps with venous return and reduces swelling and pain in the affected limb. Cold and hot compresses are strictly prohibited, and the lower limbs should not be vigorously massaged. DVT is most unstable 1-2 weeks after its formation, and caution should be exercised about the risk of embolism caused by thrombus detachment. After the overall symptoms and local tenderness are relieved, light activities can be carried out, and elastic socks can be used when getting out of bed. Appropriate ankle pump exercise
Prevention and treatment measures for VTE
1. For low-risk VTE patients, we can take basic prevention measures:
Drink plenty of water
Encourage patients to drink more water (1500-2500ml) if the condition allows, to avoid blood concentration. Intraoperative and postoperative fluid replacement therapy for surgical patients.
Raise the lower limbs
Raise the lower limbs by 20 ° -30 °, avoid placing hard pillows under the knees and excessive hip flexion. When the condition allows, raise the lower limbs to promote venous improvement of lifestyle
Quit smoking and drinking, eat low salt, low sugar, low-fat, high protein, high vitamin, easily digestible foods, control blood sugar and blood lipids, etc.
Protect lower limb blood vessels
Standardize venipuncture techniques and avoid deep vein puncture and lower limb venipuncture infusion as much as possible.
Regular assessment
Evaluate the condition of the patient's lower limbs, and promptly inform the doctor and handle any swelling, pain, skin temperature, color changes, or sensory abnormalities found.
Early activities
Encourage bedridden patients to engage in active and passive exercises in bed, and guide leg and ankle pump movements; For PICC catheterization patients, the upper limb on the catheterization side can perform fist clenching and fist releasing exercises; Encourage early mobilization based on the patient's recovery status.
2. Some intermediate risk patients can also take physical prevention measures, such as gradient pressure socks. It can be used continuously for 24 hours, effectively increasing venous return and reducing blood stasis in the calf.
If conditions permit, intermittent inflation and pressurization devices can be used.
In addition to the above two methods, some high-risk patients can also take medication as a preventive measure.
For example, oral anticoagulants, antiplatelet drugs, dextran 40 and 70, low-dose unfractionated heparin, low molecular weight heparin vitamin K antagonists, etc. Anticoagulants should be used according to medical advice and regularly reviewed. In short, for unexplained swelling, pain, and varicose veins in the lower limbs, vigilance should be heightened. Early detection and treatment of deep vein thrombosis can avoid the serious consequence of pulmonary embolism. For urbanites living in modern times, what we need to do is to exercise more and drink more water. Therefore, please don't forget to kick your legs and walk during your work and leisure time, so that your lower limb veins are unobstructed!