I've written about blood clots before on my blog, see DVT, blood clot, deep vein thrombosis. I wanted to touch on this subject again because I came across a flyer from a class I once attended which introduced nurses to an excellent tool aimed at reducing the incidence of DVT by recognizing the individuals at greatest risk. Patients need to know about this, too, so they can be vigilent and take precautions when they are at risk.
Apparently this educational endeavor is defunct because I cannot find a word about it in my Google searching. "SCORE IT" DVT Patient Profiler for Selected Patients at Risk was presented by CARE FORCE (Clot Assessment & Risk Reduction Through Education). The acronym SCORE IT cues the nurse to remember what patient types are at greater risk. The more catagories that apply to a specific patient, the greater the risk and the need for higher levels of DVT prevention protocols in the hospital to be implemented in order to prevent a blood clot from developing.
I found this program compelling and want to record the information here for reference:
S . . . Surgery Patients.
- General Anesthesia is a risk factor for postsurgical DVT development.
- All surgeries are associated with risk of DVT/General and orthopedic surgeries are associated with a higher risk of developing DVT and PE (pulmonary embolus) than other types of surgery.
- Total knee or hip replacement and hip fracture orthopedic procedures are associated with the highest postsurgical (within 1 to 2 weeks) risk of DV--over 50%.
C . . . Cancer Patients and Cardiovascular Patients
- Cancer Patients
- Chemotherapy, radiotherapy, central venous catheters, and surgery contribute to the increased risk of VTE (venous thromboembolism) in patients with cancer.
- Tamoxifen or hormone replacement therapy are risk factors for DVT
- Tumors may also cause obstruction which can contribute to venous stasis.
- Cardiovascular Patients
- Acute myocardial infarction (AMI), ischemic and non-ischemic cardiomyopahy, congestive heart failure (CHF) secondary to valvular disease, and chronic idiopathic dilated cardiomyopathy may increase the risk.
O . . . Obese Patients
- Modifiable Risk Factor
- Weight loss may decrease risk
R . . . Respiratory Failure Patients
- Acute exacerbation of chronic obstructive pulmonary disease (COPD), adult respiratory distress syndrome, moderate to severe community-acquired or nosocomial pneumonia, lung cancer, interstitial lung disease, or pulmonary hypertension are associated with increased risk.
E . . . Elderly Patients
- Bed rest, frailty, and immobility features often associated with advanced age, predispose patients to venous stasis.
- Advancing age (older than 40 years) is a risk factor for VTE.
- As the population ages, the number of cases of VTE is expected to increase.
I . . . Infection/Inflammatory Disorder/Immobile/ICU Patients
- Infection Patients
- Disseminated infections, sepsis, and serious systemic infections, including urinary tract (UTI), complicated skin and skin structure, pneumonia, and abdominal infections may lead to increased risk of DVT.
- Inflammatory Disorder Patients
- Disorders such as systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD) are associated with an increased risk of IBD.
- Immobile/ICU Patients
- Venous stasis of the lower limbs may predispose a patient to thrombosis formation
- Patients confined to bedrest for fewer than 5 days had a 21% occurrence of VTE compared to a 36% occurrence in patients on bedrest for over 10 days. [There is no source citation given for these statistics on the flyer.]
- Incidence of DVT in stroke patients with a paralyzed lower limb exceeds 50%. [No source cited.]
- Increased risk in ICU patients with medical disorders.
T . . . Trauma/Thrombophila/Thromboembolism History Patients
- Trauma Patients
- Patients with major trauma who do not receive thromboprophylaxis have a 50% risk of DVT. [No source is cited for this statistic.]
- Multiple injuries and lower extremity or pelvic fractures are associated with a higher risk of VTE.
- Thrombophilia/Thromboembolism History Patients
- Prior history of DVT/PE confers risk of a future event.
- As many as 20% of patients with confirmed thromboembolic disease have a history of DVT or PE.
- Patients with an acquired or genetic predisposition to hypercoagulable states are at risk for VTE.
If you find yourself among those at highest risk of developing a blood clot and you you are hospitalized, ask your doctor and nurse what precautions they are going to take to prevent you from developing blood clots. The options for prevention include tight white stockings on the legs (TED hose) that help improve the circulation; "squeezy" wraps to the lower legs that inflate and deflate via an electric pump (many name brands for this type of equipment); injections of blood thinning medication into the skinfolds of your abdomen (Lovenox or Fragmin); or they may simply suggest "early ambulation"--which means you are up and out of bed quickly, in a chair and walking in the hallways. If they haven't suggested any of these options, insist that they come up with a plan for you. This is required by the Joint Commision, the authority that accredits hospitals.
Patients--be concerned about pain and swelling in your legs. Often a blood clot will first appear in the back of one of the lower legs. This can occur while you are in the hospital or even a few weeks after you get home. Also be concerned about any sharp pain in the chest, wheezing breath sounds and frequent moist cough; those signs could suggest a small blood clot has gone to the lungs.
. . . .
Dangerous blood clots may develop unexpectedly within the deep veins of a lower leg. Such clots can cause deadly complications when microscopic pieces break off and clog the circulation to distant parts of the body. Clots that find their way into the brain, lungs, or heart may result in deadly or life-altering complications from stroke, pulmonary embolus, or heart attack.
Preventing a DVT is certainly much easier than curing the condition. In hospitalized patients several methods are used to enhance the flow of blood to the lower legs. First and foremost, being up and around as soon as possible, and as much as possible after surgery or while recovering from an illness is a major advantage in increasing venous flow and decreasing the chance of clots forming. Tight white compression stockings (TED hose) may be prescribed depending on the level of risk for the specific patient (see below). Mechanical "pumps" squeeze the lower legs at regular intervals in another means of prevention. For patients at the highest risk of DVT, blood thinning medication is injected daily under the skin of the abdomen.
Greater Risk of Clots for Some Patients
DVT (Deep Vein Thrombosis) can occur in almost anyone. However, certain individuals may be at increased risk for developing a DVT. Risk factors include but are not limited to:
- Recent surgical procedure (and greater chance of a DVT with a long, intense surgery and joint replacement surgeries)
- Restricted mobility from bedrest, paralysis, traveling for many hours without taking a break to walk around
- Active Cancer
- Congestive Heart Failure (CHF)--if you take "water pills" and are not sure why--ask your doctor if you have CHF
- Age greater than 40 years old
- Pregnancy and the postpartum period (6-8 weeks after delivery)
- Injury to the leg or the deep veins of the leg
- Smoking
- Use of certain medications such as birth control pills and estrogen
- Dehydration
- Polycythemia
- Obesity
- Current smoker
- Past history of having a blood clot or an inherited family tendency to develop blood clots
Spot a Clot . . . a Campaign sponsored by the Venous Disease Coalition
Check out their website to learn more about DVT and related conditions such as:
- Post Thrombotic Syndrome (PTS) After a DVT is treated and resolved, this chronic condition may result in up to 40% of all individuals. It's the result of damage done by the clot to the valves that move blood through the vein.
- Pulmonary Embolis (PE) Blood clots in the smallest vessels of the lungs.
- Thrombophila Blood that clots too easily. Hypercoagulability is another word used to describe this condition which can be inherited.
- Chronic Venous Insufficiency results when the valves in the veins that move blood don't function properly, often occurs from injury to veins caused by a DVT, from varicose veins, or as the result of an inherited condition.
Venous Disease Coalition Patient Education Resources:
The Vascular Disease Foundation has a variety of full-color brochures available for download including a great pamphlet called "Focus on Clots." (This publication was previously called "Spot a Clot," but otherwise it's the exact same informational card.)
You may also request a copy of these brochures by calling toll free: 1-888-833-4463.
Other related publications you can download:
. . .
. . .
