Prevention of venous thromboembolism
Deep vein thrombosis (DVT) may be asymptomatic in a patient confined to bed – pulmonary embolism (PE) may be the first symptom. Every hospital and clinic should have active management guidelines for the prevention of venous thromboembolism (DVT and PE). The prevention of venous thromboembolism (VTE) consists of early mobilisation, compression bandages or anti-embolism stockings, low molecular weight heparin (LMWH) and warfarin if long-term prophylaxis is indicated. The following anticoagulants may be used in special cases: fondaparinux (patients at high-risk of VTE, heparin allergy), dabigatran, rivaroxaban or apixaban (oral agents for use after elective knee and hip replacement surgery). Rivaroxaban may also be used for secondary prevention of venous thromboembolism and pulmonary embolism in an uncomplicated patient. Idiopathic VTE (no identified risk factors) is three times more likely to recur than provoked VTE (risk factors present). Indefinite treatment is therefore often recommended after idiopathic VTE. If VTE develops without any provoking factors in a patient aged less than 50 years, tests for hereditary coagulation disorders are indicated to facilitate the choice of treatment duration (indefinite or temporary) . Aspirin is mainly used for the prevention of arterial occlusion, but there is accumulating evidence on aspirin and statins in preventing recurrence of venous thromboembolism and pulmonary embolism. A patient who has a previous history of VTE, or is otherwise predisposed to thrombus formation, must be given guidance regarding high risk situations.