Thrombosis prevention

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Thrombosis prevention
Blausen 0088 BloodClot.png
A blood clot blocking a blood vessel.
Other namesThrombosis prophylaxis
ICD-10-PCS I80-I82
ICD-9-CM 437.6, 453, 671.5, 671.9

Thrombosis prevention or thromboprophylaxis is medical treatment to prevent the development of thrombosis (blood clots inside blood vessels) in those considered at risk for developing thrombosis. [1] Some people are at a higher risk for the formation of blood clots than others, such as those with cancer undergoing a surgical procedure. [2] [3] Prevention measures or interventions are usually begun after surgery as the associated immobility will increase a person's risk. [4]

Contents

Blood thinners are used to prevent clots, these blood thinners have different effectiveness and safety profiles. A 2018 systematic review found 20 studies that included 9771 people with cancer. The evidence did not identify any difference between the effects of different blood thinners on death, developing a clot, or bleeding. [2] A 2021 review found that low molecular weight heparin (LMWH) was superior to unfractionated heparin in the initial treatment of venous thromboembolism for people with cancer. [3]

There are medication-based interventions and non-medication-based interventions. [4] The risk of developing blood clots can be lowered by life style modifications, the discontinuation of oral contraceptives, and weight loss. In those at high risk both interventions are often used. [1] The treatments to prevent the formation of blood clots is balanced against the risk of bleeding. [5]

One of the goals of blood clot prevention is to limit venous stasis as this is a significant risk factor for forming blood clots in the deep veins of the legs. [6] Venous stasis can occur during the long periods of not moving. Thrombosis prevention is also recommended during air travel. [7] Thrombosis prophylaxis is effective in preventing the formation of blood clots, their lodging in the veins, and their developing into thromboemboli that can travel through the circulatory system to cause blockage and subsequent tissue death in other organs. [1] Clarence Crafoord is credited with the first use of thrombosis prophylaxis in the 1930s.

Pathophysiology of blood clot prevention

Flow chart of clot prevention.jpg

The development of blood clots can be interrupted and prevented by the use of medication, changing risk factors and other interventions. Some risk factors can be modified. These would be losing weight, increasing exercise and the cessation of oral contraceptives. Moving during periods of travel is a modifiable behavior. Preventing blood clots includes the use of medications that interrupt the complex clotting cascade and changing the proteins that are needed for clotting. Antiplatelet drugs also have an effect in preventing the formation of clots.[ citation needed ]

Medical treatments

Thrombosis prophylaxis is not only used for the prevention of deep vein thrombosis, but can be initiated for the prevention of the formation of blood clots in other organs and circumstances unrelated to deep vein thrombosis:[ citation needed ]

Epidemiology of developing blood clots

The risk of developing deep vein thrombosis, or pulmonary embolism is different than the total risk of the formation of blood clots. This is due to the observation that not all blood clots form in the lower legs. Most hospitalized medical patients have at least 1 risk factor for thrombosis that progresses to thromboembolism and this risk persists weeks after discharge. Those who remain undiagnosed and not treated prophylactically have a 26% chance of developing a fatal embolism. Another 26% develop another embolism. Between 5% and 10% of all in hospital deaths are due to pulmonary embolism (as a consequence of thrombosis). Estimates of the incidence of pulmonary embolism in the US is 0.1% persons/year. Hospital admissions in the US for pulmonary embolism are 200,000 to 300,000 yearly. [10] Thrombosis that develops into DVT will affect 900,000 people and kill up to 100,000 in the US. On average 28,726 hospitalized adults aged 18 and older with a VTE blood clot diagnosis die each year. [11] Risk of thrombosis is related to hospitalization. [4] In 2005 the UK the Parliamentary Health Select Committee determined the annual rate of death due to thrombosis was 25,000 with at least 50% being hospital-acquired. [12]

The type of surgery performed prior to the formation of blood clots influences the risk. Without prophylactic interventions, the calculated incidence of clot formation in the lower leg veins after surgery is:

As the population of the US ages, the development of blood clots is becoming more common. [14]

General risks and indications for blood clot prevention

Some risk factors for developing blood clots are considered higher that others. One scoring system analyzes the probability for clot formation by assigning a point value system to significant risk factors. [15] The benefit of treating those who are at low risk of developing blood clots may not outweigh the higher risks of significant bleeding. [16]

Risk factors for developing blood clots that are assessed prior to treatments
Risk factorNotesReferences
Previous episodes of thrombosis also a risk factor for embolism formation [17] [18] [19]
Family History of Deep Vein Thrombosis [20] [14]
Gender, and race not firmly established
increased prevalence in women during childbearing years
[14]
Smoking modifiable, difficult [19] [21]
Diabetes [18]
Arteriosclerosis [18]
Renal disease "hypercoagulable state" [18] [18]
Vasoconstriction [22]
Myocardial infarction and other types of heart diseaseHeart attack, Unstable angina Dysrhythmias Heart failure [23] [20] [22] [18]
Slow or turbulent blood flowmodifiable with exercise [22] [23] [24]
Stroke heparins contraindicated [24] [18] [24]
Sedentary life stylemodifiable with exercise [22] [19] [14]
Plaster casttransient [18]
Dehydration modifiable
also related to athletic activities and sports
[22] [20]
Acute respiratory failure [18]
Dysrhythmias [22] [23]
Shock [22]
Obesity modifiable [15] [25] [1] [22] [18] [23] [19]
Pregnancy and the post-partum period"hypercoagulable state" [18] [15] [1] [22] [20] [14]
Varicose veins [18]
Surgery length of the surgical procedure
type of operation
hip or knee surgery [14]
related to subsequent state of hypercoagulability [13]
[15] [1] [25] [19] [20] [21]
Lung disease [20]
Trauma related to immobility [15] [1] [18] [23] [14]
Estrogen-based oral contraceptive discontinuation reduces risk
related to progestogen and ethinylestradiol [26]
[15] [1] [22] [20] [26] [14] [21]
Hormone replacement therapy discontinuation reduces risk [15]
Ovarian hyper-stimulation therapy to treat infertility [15]
Compression of a vein or artery by abnormality, tumor, hematoma [15]
Pacing wires [1]
Local vein damage, incompetent valves [1] [22]
Central venous catheters [1] [23]
Dialysis catheters [1] [23]
Repetitive motion injury [1]
Immobilityassociated with air travel, long travel times and
post-surgical – modifiable risk
[1] [18] [23] [19] [14] [21] [13]
Spinal cord injury [1]
Age [1] [15] [22] [18]
Cancers

[1] [20] [14]

Sepsis [1]
Polycythemia heparins contraindicated [24] [1]
Genetic deficiencies or autoimmune disorders, Protein C and/or S deficiencycongenital; associated with warfarin necrosis, heparins contraindicated [24] [1] [27] [21]
Antiphospholipid antibody syndrome altered coagulation; heparins contraindicated [24] [1]
Factor V Leiden defect altered coagulation [1]
Prothrombin G20210A defectaltered coagulation; heparins contraindicated [24] [1]
Hyperhomocysteinimia altered coagulation; heparins contraindicated [24] [1]
Elevated factors II, VIII, IX, XI altered coagulation; heparins contraindicated [24] [1] [14]
Antithrobin III deficiency altered coagulation; heparins contraindicated [24] [1] [14]
Falls and hip fracture related to immobility [1] [19]
Selective estrogen-receptor modulators [15]
Erythropoiesis-stimulating agents [15]
Acute medical illness [15] [14]
Inflammatory bowel disease [15]
Nephrotic syndrome [15]
Myeloproliferative disorders [15]
Paroxysmal nocturnal hemoglobinnuria [15]
Thrombophilias heparins contraindicated [24] [15] [14]
Post-menopausal hormone replacement therapydiscontinuation reduces risk [15]
Right heart failure [22]
Venous inflammation/phlebitis when a thrombus forms, it is thrombophlebitis [22]
Sickle cell disease
Artificial heart valves [24]
Probability and risk estimation for developing blood clots
Major risk (=1 point)Minor risk (=2 points)
Cancer Family history of
deep vein thrombosis
ImmobilityHospitalization within
the past 6 months
Calf swelling superficial vein dilation
Recent major surgeryredness of area
Edema or swelling of only legRecent trauma
to leg
Tenderness in
the calf and/or thigh
Scoring of the risks associated with formation of blood clots
Probability determination and scoring
High probability scoring (12–7 points
3 major points OR
2 major points AND >2 minor points
Low probability scoring (3–5 points)
0 major points AND > 2 minor points
1 major point AND >2 minor points
0 major points and >3 minor point
1 major point and more than one minor point
Moderate probability scoring (varies)
all other risk combinations

Risk for subsequent blood clots

Developing blood clots is more probable after the first episode. Risk assessment and intervention for those with one or more episodes of deep vein thrombosis or blood clots in the veins utilizes the Well's test. It has been inconsistently modified by a number of publishers with the results listed below: [28]

Well's and modified Well's risk scoring

Well's and modified Well's scoring
Findingpointsreferences
D-dimer abonormal one month after stopping anticoagulants2 [28]
Age > or = to 501 [28]
male1 [28]
use of hormone at DVT onset1 [28]

Adapted for the emergency department

modified Well's scoring
Findingpointsreferences
Malignancy1 [29]
Age > or = to 501 [29]
cast on lower leg/Paralysis/paresis/1 [29]
Recent surgery or immobility1 [29]
tenderness over deep vein1 [29]
entire leg swollen1 [29]
difference of 3 cm between legs1 [29]
pitting edema of affected leg1 [29]
Collateral superficial veins1 [29]
another diagnosis more probable than DVT-2 [29]

Scoring:

General interventions

The Centers for Disease Control and Prevention have issued general guidelines describing the interventions that can be taken to reduce the risk of the formation of blood clots:

The Centers for Disease Control and Prevention recommend the following:

  • Move around as soon as possible after having been confined to bed, such as after surgery, illness, or injury.
  • If you're at risk for DVT, talk to your doctor about:
    • Graduated compression stockings (sometimes called "medical compression stockings")
    • Medication (anticoagulants) to prevent DVT.
  • When sitting for long periods of time, such as when traveling for more than four hours:
    • Get up and walk around every 2 to 3 hours.
    • Exercise your legs while you're sitting by:
      • Raising and lowering your heels while keeping your toes on the floor
      • Raising and lowering your toes while keeping your heels on the floor
      • Tightening and releasing your leg muscles
    • Wear loose-fitting clothes.
  • You can reduce your risk by maintaining a healthy weight, avoiding a sedentary lifestyle, and following your doctor's recommendations based on your individual risk factors. [7]
Venous valve 00013.gif

Interventions during travel

Seat-edge pressure from the seat on an airplane on the popliteal area may contribute to vessel wall damage as well as venous stasis. Coagulation activation may result from an interaction between cabin conditions (such as hypobaric hypoxia) and individual risk factors for the formation of blood clots. Studies of the pathophysiologic mechanisms for the increased risk of Venous thrombosis embolism or VTE after long-distance travel have not produced consistent results, but venous stasis appears to play a major role; other factors specific to air travel may increase coagulation activation, particularly in passengers with individual risk factors for VTE. [30]

Interventions for those hospitalized

Compression devices

Mechanical compression devices are used for prevention of thrombosis and are beneficial enough to be used by themselves with patients at low to moderate risk. [4] The use of fitted intermittent pneumatic compression devices before, during and after procedures is used in inpatient settings. It consists of an air pump and inflatable auxiliary compartments that sequentially inflates and deflated to provide an external 'pump' that returns venous blood toward the heart. [31] The use of intermittent pneumatic compression is common. [31] [19] [5] These devices are also placed on a surgical patient in the operating room (the intra-surgical period) and remain on the person while recovering from the surgery. [32]

The application of antiembolism stockings can be used to prevent thrombosis. [4] The correct use and properly fitted graded compression stockings can reduce the rate of thrombosis by 50%. [15] [19] :745–46 Contraindications for the use of antiembolism stockings include the presence of advanced peripheral and obstructive arterial disease, septic phlebitis, heart failure, open wounds, dermatitis and peripheral neuropathy. [33] Differences between the use of thigh-high compression stockings and shorter types to prevent blood clots exist, but remain inconsistent. [4] [5]

Assessment

There has been some success in preventing blood clots by an early risk assessment upon admission to the hospital, which is a strategy recognized by the Centers for Disease Control and Prevention. Hospitals that have participated in this effort to reduce the incidence of thrombosis found that rates of DVT decreased in some instances. [34] Some hospitals developed a mandatory assessment quantifying the risk for developing blood clots and a plan of care developed from the results. The person's risk for developing blood clots is entered into their record, 'following' them through their treatment regime. If the hospital stay exceeds three days, the person will be reassessed for risk. Clinicians are then able to apply protocols for prevention based upon best clinical practices. [35] [36]

Interventions to treat immobility

The poplitial vein can be one site of venous stasis in the lower leg. Obstruction of this vein during travel contributes to statis. Poplitial vein.jpg
The poplitial vein can be one site of venous stasis in the lower leg. Obstruction of this vein during travel contributes to statis.

Immobility is a significant risk factor in the development of thrombosis. [37] [38] [22] [25] Immediate post-surgical interventions, such as out of bed orders (OOB), are typically ordered by the physician to prevent thrombosis. These orders, typically delegated to a nurse, but may include the participation of a physical therapist and others trained to perform the intervention, are to perform range of motion (ROM) activities that include: muscle contractions of the lower legs for those who are very weak, moving the feet, wiggling the toes, bending the knees, raise and lower the legs. In addition, changes in positioning prevents immobility and shifts areas of venous stasis. If the person is too weak to perform these preventative activities, hospital personnel will perform these movements independently. Exercise of the lower extremities is a post-operative method of prophylaxis. Nursing personnel will often perform range of motion exercises and encourage frequent moving of the legs, feet, and ankles. Frequent positioning changes and adequate fluid intake. After a surgical procedure, ambulation as soon as possible is prophylactic in preventing the formation of blood clots. [38] [22] [25]

Early ambulation also prevents venous stasis and physicians order OOB activities on the same day of surgery. This is accomplished in increments. The progression of increasing mobility proceeds by: raising the head of the bed, sitting up in bed, moving to the edge of the bed, dangling the legs off the bed and then ambulating to a close chair. [19] [25]

Patient education and compliance reduces the risk of developing blood clots. These exercises and use of equipment and follow up by clinicians reduces the risk of developing blood clots. [25]

Note that if a blood clot has already formed in the deep veins of the leg, bedrest is usually prescribed and the treatment to prevent bloods with physical intervention is contraindicated.[ citation needed ]

Medication

Anticoagulants and antiplatelets

Thromboprophylaxis, such as anticoagulants or perioperative heparin, is effective for hospitalized patients at risk for VTE. [2] [39] Additional risk factors such as obesity, disease, malignancies, long surgeries, and immobility may influence the prescribed dosage. Anticoagulant medications may prevent the formation of blood clots in people who are at high risk for their development. [4] Treating blood clots that have already formed is managed by the use of anti-hemolytic ("clot busters"). Despite its effectiveness, the use of thromboprophylaxis remains under-utilized, though alerts (computer or human) in hospitals are associated with increased prescription and reductions in symptomatic VTE. [39] The list below describes some of the more common medications used to prevent blood clots. [24] Note that generally since blood clotting is inhibited, a side effect typically is increased bleeding, though it can be reversed by administering a medication that stops the bleeding or by discontinuation of the medication itself. Anti-coagulant administration is often given before the start of the operation. [25] Medications that inhibit blood clot formation include:

Medications used to prevent blood clots
Name of medicationTherapeutic/pharmologic classActionRouteOther usesNotesSide effectsReferences
aspirin antiplateletrisks for GI tract bleeding and hemorrhagic stroke [40] [41] [32] [42] [43]
dipyridamole platelet aggregation inhibitororal or intravenousAbdominal or stomach cramps, diarrhea, dizziness or lightheadedness [44] [45] [46] [41]
clopidogrel antiplatelet [45] [41]
ticlid
enoxaparin anticoagulantactivation of antiprothrombin, prevents fibrin formationslow IVplatelet count is monitored [45] [41]
dalteparin anticoagulantactivation of antiprothrombin, prevents fibrin formationIV [41]
fondaparinux anticoagulantinhibits thrombin productioninjectionaspirin not recommended with this medication [41] [24] [2]
dabigatran inhibits prothrombin [41]
bivalirudin inhibits prothrombinoften given with aspirin [41]
argatroban anticoagulantinhibits prothrombinIValternative to heparin in those developing heparin-induced thrombocytopenia [41] [24]
desirudin anticoagulantinhibits prothombininjectionused with hip replacement [41] [24]
eptifiatide antiplatelet [41]
tirofiban antiplatelet [41]
ticlopidine antiplatelet [41]
pentocifylline antiplatelet [41]
diyridamole anitplatelet [41]
cilostazol antiplatelet [41]
rivaroxaban inhibits factor Xause with antiplatelets cautionedGI bleeding [41]
warfarin anticoagulantThrombin inhibitor;IV [24]
lipirudin anticoagulantinhits prothrombinIVtreatment may extend to 10 days [24]
dextran [4]

Heparins

Adding heparin to the use of compression stockings may prevent thrombosis for those of higher risk. [4] [47]

Heparin Prophylaxis
nameactionstructurereferences
Low-molecular weight heparin
(example: Reviparin)
[48] [49] [50] [51] [52]

The discontinuation of contraceptives also prevents blood clots. [15]

Herbal interactions

The therapeutic effects of warfarin may be decreased by valerian. Anticoagulants can be affected by chamomile. Dong quai, garlic, ginger, Ginkgo biloba, bilberry and feverfew can increase bleeding time. These same herbal supplements taken with warfarin increased prothrombin time. [24]

Dietary interactions

By containing significant content of vitamin K, some foods act as antagonists to antiplatelet and anticoagulant medications; these include green leafy vegetables, like spinach, legumes, and broccoli. [24]

Contraindications

Preventing blood clots with medication is not considered safe in the following circumstances:

Research

An international registry and risk assessment calculator is being used to centralize data on post-surgical venous thrombosis and its prevention. [53] Hospitals are implementing a multi-disciplinary approach to prevent of blood clots. This includes adequate assessment of the risks, follow up on missed doses of medication and instituting a 'patient-centered' approach endorsed by the Joint Commission. [34] Recommendations regarding the prevention of blood clots vary widely between clinicians and treatment facilities. Research continues to clarify these discrepancies. [5] The metabolic state of hypercoagulability (the tendency to form blood clots) tests are being developed. These include the evaluation of the thrombin–antithrombin complexes (TAT), low levels of the anticoagulants ATIII and protein C, but these tests are not yet widely available. [13]

Related Research Articles

<span class="mw-page-title-main">Thrombosis</span> Medical condition caused by blood clots

Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets (thrombocytes) and fibrin to form a blood clot to prevent blood loss. Even when a blood vessel is not injured, blood clots may form in the body under certain conditions. A clot, or a piece of the clot, that breaks free and begins to travel around the body is known as an embolus.

<span class="mw-page-title-main">Pulmonary embolism</span> Blockage of an artery in the lungs

Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include shortness of breath, chest pain particularly upon breathing in, and coughing up blood. Symptoms of a blood clot in the leg may also be present, such as a red, warm, swollen, and painful leg. Signs of a PE include low blood oxygen levels, rapid breathing, rapid heart rate, and sometimes a mild fever. Severe cases can lead to passing out, abnormally low blood pressure, obstructive shock, and sudden death.

<span class="mw-page-title-main">Venous thrombosis</span> Blood clot (thrombus) that forms within a vein

Venous thrombosis is blockage of a vein caused by a thrombus. A common form of venous thrombosis is deep vein thrombosis (DVT), when a blood clot forms in the deep veins. If a thrombus breaks off (embolizes) and flows to the lungs to lodge there, it becomes a pulmonary embolism (PE), a blood clot in the lungs. The conditions of DVT only, DVT with PE, and PE only, are all captured by the term venous thromboembolism (VTE).

Factor V Leiden is a variant of human factor V, which causes an increase in blood clotting (hypercoagulability). Due to this mutation, protein C, an anticoagulant protein that normally inhibits the pro-clotting activity of factor V, is not able to bind normally to factor V, leading to a hypercoagulable state, i.e., an increased tendency for the patient to form abnormal and potentially harmful blood clots. Factor V Leiden is the most common hereditary hypercoagulability disorder amongst ethnic Europeans. It is named after the Dutch city of Leiden, where it was first identified in 1994 by Rogier Maria Bertina under the direction of Pieter Hendrick Reitsma. Despite the increased risk of venous thromboembolisms, people with one copy of this gene have not been found to have shorter lives than the general population.

<span class="mw-page-title-main">Deep vein thrombosis</span> Formation of a blood clot (thrombus) in a deep vein

Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enlarged veins in the affected area, but some DVTs have no symptoms. The most common life-threatening concern with DVT is the potential for a clot to embolize, travel as an embolus through the right side of the heart, and become lodged in a pulmonary artery that supplies blood to the lungs. This is called a pulmonary embolism (PE). DVT and PE comprise the cardiovascular disease of venous thromboembolism (VTE). About two-thirds of VTE manifests as DVT only, with one-third manifesting as PE with or without DVT. The most frequent long-term DVT complication is post-thrombotic syndrome, which can cause pain, swelling, a sensation of heaviness, itching, and in severe cases, ulcers. Recurrent VTE occurs in about 30% of those in the ten years following an initial VTE.

Low-molecular-weight heparin (LMWH) is a class of anticoagulant medications. They are used in the prevention of blood clots and treatment of venous thromboembolism and in the treatment of myocardial infarction.

<span class="mw-page-title-main">Inferior vena cava filter</span>

An inferior vena cava filter is a medical device made of metal that is implanted by vascular surgeons or interventional radiologists into the inferior vena cava to prevent a life-threatening pulmonary embolism (PE) or venous thromboembolism (VTE).

<span class="mw-page-title-main">Renal vein thrombosis</span> Medical condition

Renal vein thrombosis (RVT) is the formation of a clot in the vein that drains blood from the kidneys, ultimately leading to a reduction in the drainage of one or both kidneys and the possible migration of the clot to other parts of the body. First described by German pathologist Friedrich Daniel von Recklinghausen in 1861, RVT most commonly affects two subpopulations: newly born infants with blood clotting abnormalities or dehydration and adults with nephrotic syndrome.

<span class="mw-page-title-main">Rivaroxaban</span> Anticoagulant drug

Rivaroxaban, sold under the brand name Xarelto among others, is an anticoagulant medication used to treat and prevent blood clots. Specifically it is used to treat deep vein thrombosis and pulmonary emboli and prevent blood clots in atrial fibrillation and following hip or knee surgery. It is taken by mouth.

<span class="mw-page-title-main">Dalteparin sodium</span> Pharmaceutical drug

Dalteparin is a low molecular weight heparin. It is marketed as Fragmin. Like other low molecular weight heparins, dalteparin is used for prophylaxis or treatment of deep vein thrombosis and pulmonary embolism to reduce the risk of a stroke or heart attack. Dalteparin acts by potentiating the activity of antithrombin III, inhibiting formation of both Factor Xa and thrombin. It is normally administered by self-injection.

<span class="mw-page-title-main">Compression stockings</span> Compression garment

Compression stockings are a specialized hosiery designed to help prevent the occurrence of, and guard against further progression of, venous disorders such as edema, phlebitis and thrombosis. Compression stockings are elastic compression garments worn around the leg, compressing the limb. This reduces the diameter of distended veins and increases venous blood flow velocity and valve effectiveness. Compression therapy helps decrease venous pressure, prevents venous stasis and impairments of venous walls, and relieves heavy and aching legs.

<span class="mw-page-title-main">Post-thrombotic syndrome</span> Medical condition

Post-thrombotic syndrome (PTS), also called postphlebitic syndrome and venous stress disorder is a medical condition that may occur as a long-term complication of deep vein thrombosis (DVT).

Hypercoagulability in pregnancy is the propensity of pregnant women to develop thrombosis. Pregnancy itself is a factor of hypercoagulability, as a physiologically adaptive mechanism to prevent post partum bleeding. However, when combined with an additional underlying hypercoagulable states, the risk of thrombosis or embolism may become substantial.

<span class="mw-page-title-main">Venous stasis</span> Medical condition

Venostasis, or venous stasis, is a condition of slow blood flow in the veins, usually of the legs.

<span class="mw-page-title-main">Intermittent pneumatic compression</span>

Intermittent pneumatic compression is a therapeutic technique used in medical devices that include an air pump and inflatable auxiliary sleeves, gloves or boots in a system designed to improve venous circulation in the limbs of patients who have edema or the risk of deep vein thrombosis (DVT), pulmonary embolism (PE), or the combination of DVT and PE which is venous thrombeombolism (VTE).

<span class="mw-page-title-main">Edoxaban</span> Anticoagulant drug

Edoxaban, sold under the brand name Lixiana among others, is an anticoagulant medication and a direct factor Xa inhibitor. It is taken by mouth.

<span class="mw-page-title-main">Betrixaban</span>

Betrixaban is an oral anticoagulant drug which acts as a direct factor Xa inhibitor. Betrixaban is FDA approved for venous thrombosis prevention in adults hospitalized for an acute illness who are at risk for thromboembolic complications. Compared to other directly acting oral anticoagulants betrixaban has relatively low renal excretion and is not metabolized by CYP3A4.

<span class="mw-page-title-main">Apixaban</span> Anticoagulant medication

Apixaban, sold under the brand name Eliquis, is an anticoagulant medication used to treat and prevent blood clots and to prevent stroke in people with nonvalvular atrial fibrillation through directly inhibiting factor Xa. Specifically it is used to prevent blood clots following hip or knee replacement and in those with a history of prior clots. It is used as an alternative to warfarin and does not require monitoring by blood tests or dietary restrictions. It is taken by mouth.

Prothrombin G20210A is a genetic condition that increases the risk of blood clots including from deep vein thrombosis, and of pulmonary embolism. One copy of the mutation increases the risk of a blood clot from 1 in 1,000 per year to 2.5 in 1,000. Two copies increases the risk to up to 20 in 1,000 per year. Most people never develop a blood clot in their lifetimes.

<span class="mw-page-title-main">Superficial vein thrombosis</span> Medical condition

Superficial vein thrombosis (SVT) is a blood clot formed in a superficial vein, a vein near the surface of the body. Usually there is thrombophlebitis, which is an inflammatory reaction around a thrombosed vein, presenting as a painful induration with redness. SVT itself has limited significance when compared to a deep vein thrombosis (DVT), which occurs deeper in the body at the deep venous system level. However, SVT can lead to serious complications, and is therefore no longer regarded as a benign condition. If the blood clot is too near the saphenofemoral junction there is a higher risk of pulmonary embolism, a potentially life-threatening complication.

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