The Net Guide: Deep Vein Thrombosis

MDNG Hospital Medicine, August 2010, Volume 4, Issue 4

The Educated PatientDeep Vein Thrombosis

Send your patients here to learn about the process of clotting in deep vein thrombosis as well as the causes, associated conditions, treatments, and possible lifestyle changes to help prevent DVT. For example, in the “When Should I Seek Medical Care for Deep Vein Thrombosis?” section, the authors relay that while “leg swelling, redness, and pain may be indicators of a blood clot and should not be ignored,” they may be symptoms of other conditions; however, if there is associated chest pain or shortness of breath, there may be reason to believe pulmonary embolus is at play and medical attention should be sought.

Link Code: h41230

Are You at Risk for Deep Vein Thrombosis?

This article, featured on the Center for Disease Control website, advises patients on what they need to know about DVT in order to assess their risk and also shares some prevention tips. Among the factors highlighted for developing DVT or a pulmonary embolism (PE) are: major surgery, increased estrogen from birth control pills, chronic illnesses like heart disease, and obesity. The site goes on to mention common symptoms, including swelling, pain, and tenderness, and also describes what a PE feels like in order for patients to recognize the symptoms (i.e., difficulty breathing, unusually faster heart beat). Additionally, the site lists some steps that individuals can take including: getting up to walk every two to three hours, tightening and releasing the leg muscles, and exercising regularly.

Link Code: h41231

Your Orthopedic Connection: Deep Vein Thrombosis

In addition to providing information on what DVT is, the causes, contributing factors, symptoms, consequences, and more, the site provides detailed information on how it is diagnosed, mechanical and pharmacological treatments, postoperative treatment, and the state of current research. For example, the site lists what a patient can expect after undergoing surgery or a procedure with regard to expected recovery time. In the “Early Movement and Rehabilitation” section, patients are informed of the likelihood that they may need to begin “physical therapy, including joint range of motion, gait training and isotonic/isometric exercises.” Likewise, in the “Postoperative Treatment” section, the patient is informed that the “risk of developing DVT extends for at least three months after joint replacement surgery.”

Link Code: h41232

Online CMEDeep Vein Thrombosis in Focus: Expert Perspectives on Reducing the Burden of Venous Thromboembolism -- Guideline-Based VTE Risk Stratification Upon Hospital AdmissionCredits: 0.50

Fee: Free

Expires: December 10, 2010

Multimedia: Audio

This activity is designed to help physicians “apply evidence-based guidelines and quality measures for VTE risk stratification in the acute-care setting,” and “implement guideline-based VTE prophylaxis in at-risk hospitalized patients.”

Link Code: h41330

Venous Thrombosis

Credits: 1.00

Fee: $20.00

Expires: June 1, 2013

Multimedia: Audio/Video/Slides

This activity will focus on helping physicians better diagnose DVT, update their “knowledge on parenteral and oral anticoagulant therapy,” and “impart new information related to genetic prothrombotic risk factors.”

Link Code: h41331

eAbstractsPlastic Surgeon Compliance with National Safety Initiatives: Clinical Outcomes and "Never Events"Journal: Plastic and Reconstructive Surgery (August 2010)

Authors: Murphy R, Peterson E, Adkinson J, et al.

Purpose: The authors sought to examine whether faculty was compliant “with venous thromboembolism and surgical-site infection prophylaxis” and also to evaluate the “incidence of adverse outcomes in patients at risk.”

Results: Researchers “performed retrospective chart reviews on 243 patients who underwent abdominoplasty or panniculectomy from 2000 to 2007 and documented demographics and adverse outcomes.” They found that “despite very good compliance with safe practice initiatives, significant adverse outcomes occurred” and obesity was the only pervasive risk factor.” The authors suggest that a need for “compliance with quality measures” exists.

Link Code: h41530

Venous Compression for Prevention of Postthrombotic Syndrome: A Meta-analysisJournal: American Journal of Medicine (August 2010)

Authors: Musani M, Matta F, Yaekoub A, et al.

Purpose: The study was designed “to determine the effectiveness of venous compression stockings or compression bandages on the reduction of postthrombotic syndrome in patients with deep venous thrombosis.”

Results: The researchers evaluated a number of trials in multiple languages published in PubMed through June 2009 and a “meta-analysis was performed.” The team closely studied five “randomized trials of patients with deep venous thrombosis.” The researchers found that “venous compression reduced the incidence of postthrombotic syndrome, particularly severe postthrombotic syndrome.”

Link Code: h41531

Transdermal Hormone Therapy and the Risk of Stroke and Venous ThrombosisJournal: Climacteric (July 30, 2010)

Authors: Speroff L

Purpose: To evaluate the association between transdermal horomone therapy and the risk of stroke and venous thrombosis.

Results: Recent studies have “prompted the clinical promotion of transdermal treatment as 'safer.'” However, the author states that there are reasons “to be cautious regarding postmenopausal transdermal hormone therapy, especially in regard to stroke.” Based on highlighted research, the author states that “clinicians should administer low doses of estrogen to women with risk factors for stroke, and the transdermal route of administration is indicated for women at high risk for venous thrombosis and for older postmenopausal women, especially for women with stroke risk factors.”

Link Code: h41532

Lower Incidence of Venous Thrombosis with Temporary Active-fixation Lead Implantation in Mobile PatientsJournal: Europace (July 28, 2010)

Authors: García Guerrero J, Fernández de la Concha Castañeda J, López Quero D, et al.

Purpose: The team sought to evaluate methods of producing lower incidences of venous thrombosis while using temporary active-fixation lead implantation.

Results: The researchers prospectively assessed an “active-fixation lead” that allowed normal ambulation. The team performed duplex ultrasound to determine DVT incidence prior to explantation. To “reduce possible false negatives, ventilation/perfusion scintigraphy was also performed.” The results revealed that in the 75% of patients with moderate or high mobility, there were no DVT cases, and the “6.4% DVT incidence was limited to patients with low mobility and was significantly lower than the norm for this procedure.”

Link Code: h41533

Clinical TrialsPoint of Care Ultrasound (US) Versus Detailed Radiology US for Deep Vein Thrombosis (DVT)Study Type: Observational

Age/Gender Requirements: 18 years (male/female)

Sponsor: University of Missouri-Columbia

Purpose: The study is designed to “assess the ability of intensivists to evaluate for deep vein thrombosis using 2 point compression ultrasonography.”

Link Code: h41630

Efficacy and Safety Study of Apixaban for the Treatment of Deep Vein Thrombosis or Pulmonary EmbolismStudy Type: Interventional

Age/Gender Requirements: 18 years (male/female)

Sponsor: Bristol-Myers Squibb

Purpose: The study is designed to “evaluate the effects of an investigational blood thinner, apixaban, in preventing venous thromboembolic (VTE) recurrence or death in patients with deep vein thrombosis (DVT) or pulmonary embolism (PE).”

Link Code: h41631

Feasibility Study of Exercise in Patients with Leg Blood Clots (EXPERT)Study Type: Interventional

Age/Gender Requirements: 21-75 years (male/female)

Sponsor: University of Oklahoma

Purpose: The study is designed to “assess the feasibility of determining the effects of a structured exercise program started two to four weeks after diagnosis of a first episode lower-extremity deep vein thrombosis (DVT).” It will take place for 12 weeks.

Link Code: h41632

Pharma FocusThe Educated PatientLovenox (enoxaparin)

According the website, patients can stay “in the know” about Lovenox by checking out the resources available here. Visitors can learn how the anticoagulant drug works to prevent DVT and pulmonary embolisms from occurring. The patient can also read about when the drug should not be used and any possible side effects, including irritation, bruising, redness of the skin, and anemia. In the “My Doctor has Prescribed Lovenox” section, visitors can learn about how to inject the drug and other important information through a video, text or slides. Here, they can also read the answers to frequently asked questions and download informative PDFs.

Link Code: h41233

Clinical TrialsComparison of Arixtra vs. Lovenox to Prevent Blood Clots in Medically Ill Patients (BRiEF)Study Type: Interventional

Age/Gender Requirements: 40 years (male/female)

Sponsor: Lehigh Valley Hospital

Purpose: The researchers will compare Arixtra to Lovenox in the prevention of blood clots in medically ill intensive care patients.

Link Code: h41633

From the HCPLive NetworkFDA Approves First Generic Version of Enoxaparin Sodium Injection

The FDA last week approved the first generic version of Lovenox (enoxaparin sodium injection), an anti-coagulant drug used for multiple indications including prevention of deep vein thrombosis (DVT), a potentially deadly blood clotting condition. Prior to approval, the FDA received a citizen petition that “questioned the approval criteria for generic enoxaparin sodium injection.”

CoaguSense’s Home-Use Blood Coagulation System Gets FDA OK

Located in Fremont, CA, CoaguSense has obtained FDA approval of its portable PT/INR (Prothrombin Time/International Normalized Ratio) analyzer for patient self-testing (PST) by prescription. Consisting of a low-cost meter and disposable test strip, the device detects blood clotting time for patients stabilized on oral anti-coagulants warfarin or Coumadin.