Deep vein thrombosis primary prevention

Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Primary prevention includes the strategies that help to avoid the development of disease. Awareness of Deep venous thrombosis is the best way to prevent this condition.

Primary prevention
Walking is an effective preventative measure. It prevents backing up of blood in the lower limb vessels. Soleus is a powerful lower limb muscle which assist in walking. Also, in upright posture, it is responsible for pumping venous blood back into the heart from the periphery, and is often called the skeletal-muscle pump, peripheral heart or the sural (tricipital) pump.

Anticoagulants and mechanical measures may also be used. In 2012, the American College of Chest Physicians (ACCP) released their 9th edition of clinical guidelines, which included recommendations on VTE prevention. The recommendations were given strengths with "grades", depending upon the evidence for them.

Lifestyle modifications
The most common lifestyle risk factors for venous thromboembolism are:
 * 1) Obesity,
 * 2) Inactivity,
 * 3) Cigarette smoking,
 * 4) Avoid dehydration,
 * 5) Maintain normal blood pressure.

Surgery patients
Surgery patients are at an increased risk of forming a DVT.

I) In patients who have undergone non-orthopedic surgery, depending upon the risk of VTE, risk of major bleeding, and patient preferences, following are potential recommended treatments.
 * Early ambulation (walking).
 * Mechanical prophylaxis (intermittent pneumatic compression [IPC] or graduated compression stockings [GCS]).
 * Drugs (low-molecular-weight heparin [LMWH], low-dose-unfractionated heparin [LDUH])

II) In major orthopedic surgery patients—those undergoing total hip replacement, total knee replacement, and hip fracture surgery—additional drug options, such as fondaparinux and aspirin, are recommended (1B), though LMWH is preferred (2B or 2C). IPC is an option (1C).

Pregnancy
The risk of VTE is increased in pregnancy by about 4-fold due to a more hypercoaguable state, a likely adaptation against fatal postpartum hemorrhage.

Travelers
There is clinical evidence that suggest, wearing compression socks, on long haul flights, reduces the incidence of thrombosis. A randomised study in 2001 compared two sets of long haul airline passengers, one set wore travel compression hosiery the others did not. The passengers were all scanned and tested to check for the incidence of DVT. The results showed that asymptomatic DVT occurred in 10% of the passengers who did not wear compression socks. The group wearing compression had no DVTs. The authors concluded that wearing elastic compression hosiery reduces the incidence of DVT in long haul airline passengers. .

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