The concept of venous thromboembolism (VTE) is such that,

it is associated with the manifestation of both Deep vein

thrombosis (DVT) and pulmonary embolism (PE) .

VENOUS THROMBOEMBOLISM (VTE)

 CHARACTERISTICS

 It is composed of a
combination of factors from
the Virchow’s triad.
 It is located in the Venous
sinusoids of muscles and
valves in veins.
 It is composed of mainly
fibrin.
 It is utilized for the purpose
of treating anticoagulants.
THE PRACTICAL ESSENTIALS

 Venous thromboembolism (VTE) is basically associated with two

inter-related conditions forming a part of the same spectrum,
pulmonary embolism and deep vein thrombosis (DVT) (Ambrosino et
al., 2017).
 The diagnosis must be taken into consideration by the confirmation of
objective testing.
 Patients suffering from deep vein thrombosis (DVT) is usually treated
by considering them as an outpatient.
 Anatomy

 It is a major preventable cause of mobility and

mortality.
 It occurs in areas of decreased or mechanical
blood flows.
 As a result of blood flows, the tension of oxygen
declines.
 The diagnosis and treatment of the lower
extremity deep venous thrombosis is dependent
upon the anatomic location.
 Continued

 Deep Venous Thrombosis is associated with more amount

of blood clots in the form of deep vein in the body.
 The common area for Deep Venous Thrombosis is in the
lower limbs.
 In the upper extremity, Deep Venous Thrombosis are less
common.
 Blood work may be done in initial stage however; a test
called D-dimer, which is used for detecting clotting
activity.
 In case of DVT is important to perform an ultrasound of
the leg.
 Physiology

 It tends to occur in areas of decreased mechanical altered

flow of blood which are adjacent to the flow of veins.
 These valves helps in the promotion of deceased blood
flow.
 Most of the time of ventilation perfusion lungs scan is also
performed.
 Mention can be made regarding the fact that, both the tests
are useful as it helps to identify the intravenous dyes in the
arteries of the lung by looking at the blockage of clot.
 Continued

 The objective of the therapy of VTE is regarding the

prevention of the extension of thrombus, PE for the
purpose of relieving the symptoms within a short period of
time.
 LMWH has changed the nature of the landscape of the
treatments in case of both DVT and PE by providing home
remedies and with an alternative long-term anticoagulant
in case of that population in whom warfarin is not
effective and contraindicated.
 Pathophysiology

 The clinical condition of DVT is such that, it is associated

with both the cardinal signs and symptoms .
 In this regard, a number of factors are associated with high
risk factors.
 The nature of DVT is such that, the thrombi develops due
to hyper coagulation and stasis surrounding the valve
sinuses.
 In the initial stage, the majority of the thrombi starts in the
calf.
 These blood clots are made of fibrin and red blood cells.
 Continued

 The flow of blood and the ability of a clotting help a

human being to stay alive. However, in some cases, blood
clotting can be a serious issue and leads to a dangerous
situation.
 It is associated with asymptomatic or cause pain by
swelling an extremity and pulmonary embolism.
 In case of duplex ultra sonography, DVT is detected and
the detection of negative results helps in the exlusion of
DVT.
 Incidence above the age of 70 years

 The incidence among adults is much more.

 However, in case of adults aged above 70 years, the
condition becomes more serious as a result of associated
risks.
 These risks often lead to low eyesight and issues in
walking.
 In case of patients above 70 years, DVT is associated with
long term complications including venous insufficiency
with or without the post phlebitic syndrome.
 Continued

 In older patients, for the purpose of treating DVT, surgical

operations are required.
 It creates significant impact upon both morbidity and
mortality in elderly patients above the age of 70.
 The risk factors includes surgery and immobilization.
 Venous thrombosis and its consequences are much more
serious in case of patients above 70 because; it is
associated with lower levels of anticoagulant proteins,
including protein C and antithrombin.
ASSOCIATED RISKS
The risks of venous thromboembolism
(vte) are associated with various
factors including-
 Age.
 Major surgeries.
 Previous trauma.
 Limb paralysis.
 Malignancy.
 Clinical Problems
 The clinical problems are associated with various factors .
 It is worth mentioning that, both Deep venous thrombosis (DVT) and
pulmonary embolism (PE) in collaboration has been comprising the
spectrum of the venous thromboembolic disease (VTE) (Cohen et al.,
2017).
 In this regard, mention can be made regarding the fact that, from the very
beginning, the venous thromboembolic disease (VTE), has been a major
cause of increasing rate of hospitalization for both adults and children .
 As a result of this, the major surgeries including the procedure of
childbirth becomes very complicated causing (Ay, Pabinger & Cohen,
2017).
 It is often accompanied with significant death risks and long term
syndromes involving postphlebitic syndrome and core pulmonale.
Historical representation

 Historically, before the advent and widespread of heparin, it was observed

that more than 20% of the patients suffering from DVT died.
 It is noteworthy to mention here that, these clinical contributions were not
adequate for the diagnosis of venous thromboembolic disease (VTE).
 This is due to the reason that, the existing modalities also plays significant
role however; the nature of their characteristics are such that, it needs to be
evaluated and identified and thereafter incorporate them into cost-
effective diagnostic strategies (Connors, 2017).
 It is evident that, the historical management of heparinization has
increased the rates of hospitalization.
 With the utilization of LMWH , the clinical methods have become
standard and the complications associated with anti-coagulation will
reduce.
 However, the patients who are not capable of receiving anticoagulants and
others who cannot receive anticoagulants at all complicates the successful
management of their venous thromboembolic disease (VTE) (Fang et al.,
2017).
Diagnosis of VENOUS THROMBOEMBOLISM (VTE)

 From the very inception, the diagnosis of both venous

thromboembolic disease (VTE) AND DVT has been sharing common
principles which includes the development of the estimation of
clinical likelihood.
 These estimates are compared efficiently in regard to the underlying
probabilities by developing them independently by way of laboratory
test, research and studies (Ferroni et al., 2017).
 In this context, it can be stated that, the nature of the operational
procedures are such that, it differs from both DVT and VTE. This is
due to the reason, the diagnosis of both DVT and VTE are mentioned
separately.
Primary risk factors

The primary risk factors in case of VTE includes-

 From the very beginning, the pathogenesis of both DVT and VTE are
based upon the concept of Virchow’s trial.
 The limitation of blood flow.
 Endothelial injury.
 Hypercoaguable state.
It is noteworthy to mention here that, each of these risk factors are
associated with the development of venous thromboembolic disease
(VTE) which is either hereditary or acquired (Gibson et al., 2017).
 Treatment of VTE
The treatment of VTE is associated with various clinical factors. It is worth
mentioning that, anticoagulation is identified as the most common form of
treatment used for treating the patients of VTE. In this regard, it is
pertinent to mention here that, thrombosis of superficial veins and those
which are distal towards the brachial vein does not require active treatment
with anticoagulation. Inferior vena cava filter is another method of
treatment in which the filter is placed after the anticoagulation has failed to
provide the ultimate results (Heit et al., 2017).The method of aggressive
clot removal is also taken into consideration in some cases. It is associated
with the process of thrombolytic therapy in case of DVT which is
performed in case of massive conditions. It serves to be appropriate in
cases associated with DVT along with thoracic outlet compression. The
process of secondary prevention and prophylaxis is also used to treat VTE
(Khorana et al., 2017).
 Anticoagulation for VTE
 The setting of anticoagulation treatment is related to both outpatient and
impatient. However, mention can be made regarding the fact that, the
outpatient treatment has various advantages.
 These advantages are associated with low cost by providing high level of
treatment to the patients for the purpose of easing their pain.
 On the other hand, the impatient treatment involves active monitoring and
immediate responses to certain clinical changes.
 It is noteworthy to mention here that, from time to time, a substantial
number of patients suffering from VTE are treated as outpatients
(Laliberté et al., 2018).
 However, these treatments are only accessible to limited number of
patients having low risk. In few cases, the outpatient treatment can be
taken into consideration.
Anticoagulation and pregnancy

 The condition of VTE and its association with pregnancy is not

known to all. However, it is believed that, the condition is
associated with much serious consequences and greater
substantiality which is much more serious than that of non-
pregnant women. I
 t is worthwhile to mention here that, only two-thirds of DVT
can be observed before delivery and these incidences are
basically distributed fairly throughout the pregnancy.
 It can be observed that, a percentage of 40-60% of PE can be
observed during 5-6 weeks after the delivery.
 It is pertinent to mention here that, the predilection of DVT can
be observed in the left leg during pregnancy because, of
underlying compression effects on the left iliac vein.
Right time to inform the patient

 It is important to inform the patient accordingly regarding their serious

condition.
 The condition of Venous thromboembolism is associated with serious
issues which are caused as a result of blood clot n the deep venous
system.
 Therefore, it is important to maintain balance between blood clotting
in order to obstruct the continuous flow of blood.
 Any kind of blood thinner both orally or by injection should be taken
as prescribed by the physician.
 In case of any failure to comply with the instructions provided by the
physician, can increase further risk.
Measures of Clinical Performance

It is noteworthy to mention here that, most of the National Programs have

developed clinical performance measures for the purpose of taking
care of conditions related to hypertension. These centers include-
 Centers for Medicare & Medicaid Services
 Quality measures for Accountable Care Organizations (ACO)
 Physician Quality Reporting Measures for Group Practice Reporting
Option (GPRO)
 Use of certified Electronic Health Record technology (MU).
Clinical performance Measures for VTE

The clinical performance measures for VTE

can be categorized as-
 The programs having relevant measures
can be considered to have created serious
impact upon the community. However,
certain specifications may vary in regard
to the inclusion and exclusion of
population.
 Monthly INR are received by the health
beneficiaries from time to time.
Therapies other than anticoagulation

 The therapies other than anticoagulation include platelet monitoring

by using impatient process. Mention can be made regarding the fact
that, a high percentage of patients diagnosed with VTE have received
intravenous UFH therapy as a part of their treatment (Raskob et al.,
2018). In this way, their platelet counts are monitored in regard to the
defined parameters including nomogram or protocol.
 The other therapy is the anticoagulation overlap therapy (inpatient).
In this case, the percentage of people diagnosed with VTE receives
overlap of parenteral (intravenous or subcutaneous) anticoagulation
and warfarin as a part of their treatment. In case of patients receiving
such treatment for a time period less than five days are accessible to
parenteral anticoagulation therapy
VTE discharge instructions

The percentage of patients diagnosed with VTE are discharged from

clinical observations after issuing a discharge instruction form in
written duly signed by the higher authority of such institution by
addressing these criteria-
 Compliance procedures.
 Dietary advices.
 Monitoring and regular follow-ups.
 Relevant information about certain drugs and their adverse effect .
 Negative trials are sometimes sought.
Conclusion

In the conclusion, it can be stated that, the condition of venous

thromboembolism (VTE) is a serious condition and is associated with
various medications and treatments. However, an under-observed
patient gains better results under constant care. Therefore, it can be
concluded that, it is important to comply with the underlying factors
for the purpose of enhancing reliability and accuracy.
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