From the Editor’s perspective …
Article Outline
Cindy Lewis, MSN, RN
At our annual Society for Vascular Nursing conference this past June, we were honored to hear Melanie Bloom speak of her story and that of her husband, NBC News correspondent David Bloom, who died as a result of DVT and PE. Melanie shared what she learned about the risk factors of DVT, such as prolonged immobility, and how this, combined with dehydration, may have contributed to the development of her husband’s blood clot. Long-haul flights also increase the risk, and David had recently been traveling back and forth on assignment. David Bloom also had a silent risk factor, Factor V Leiden, an inherited blood coagulant disorder that can increase a person’s risk of DVT. Having three or more risk factors for DVT may put someone at risk and lead to a potentially fatal PE. David Bloom had four risk factors. Melanie also learned that DVT can be prevented if you are aware of the risk factors, signs, and symptoms.
According to the American Heart Association, up to two million Americans are affected annually by DVT.1 Of those who develop PE, up to 300,000 will die each year.2, 3 More Americans die annually from DVT and PE than from breast cancer and acquired immune deficiency syndrome combined, which account for approximately 55,000 deaths annually.2, 3 Yet, according to a national survey published by the American Public Health Association, 74% of Americans continue to have little or no awareness of DVT. DVT is also among the leading causes of preventable hospital death. According to a US multi-study, 58% of patients who developed DVT while in the hospital received no preventive treatment despite the presence of multiple risk factors and overwhelming data that prophylaxis is effective at reducing these events.4 DVT assessment and prophylaxis are now integral components in the Surgical Care Improvement Project, a national quality improvement project designed to improve surgical care in hospitals.
We all know that the most effective predictor of DVT is a history of the disease. Other risk factors include vascular damage, hypertension, and predisposition to blood clotting. However, in the last 25 years we have witnessed a dramatic increase in the prevalence of obesity and overweight individuals in the United States. The prevalence of obesity has increased from 13% to 31%.5 Obesity is becoming the fastest growing major health problem in the United States. Although obesity has traditionally been recognized as an independent risk factor for DVT and PE, its close association with hypertension and other risk factors for cardiovascular disease supports a secondary risk factor for vascular complications. One study evaluated obesity, DVT, and PE during a 21-year period. Obese patients were 2.5 times as likely to have DVT and 2.2 times as likely to have PE. Age also was found to be predictive of these vascular complications. The odds of developing PE and DVT were more than five times higher for obese patients aged less than 40 years than for their non-obese peers. In addition, obese women aged less than 40 years had the highest risk of DVT. They were six times as likely as non-obese women aged less than 40 years to have DVT. For men aged less than 40 years, obesity more than tripled the risk of DVT.5 Obesity is considered by many to be an independent risk factor for thrombosis. In addition, obese patients undergoing surgery may require higher doses of anticoagulants than non-obese patients. It is important that obesity be recognized as a risk factor for DVT.
Even if a PE never develops, research shows that patients treated for DVT in acute care hospitals may have a mortality rate as high as 30% three years after discharge.6 It is therefore important to know who is at risk for DVT and what pharmacologic and nursing interventions will decrease the chance of its developing. As nurses, we play an integral role in helping to prevent DVT. We can identify patients with risk factors and integrate DVT screening tools into our patient medical history reviews. We must ensure appropriate care for patients with DVT by implementing evidence-based guidelines and decreasing the time from diagnosis to treatment. Using preprinted order sets that address anticoagulant therapy during the first 24 hours of treatment, along with elastic stockings and pneumatic compression devices, should be automatic for all inpatient admissions. We must increase and share our knowledge of the cause, diagnosis, and treatment of DVT with our patients and our communities. We must educate our patients in the prevention, detection, and treatment of DVT. Our role is vital to improving the coordination of patient care through the continuum using nurse-managed interventions for DVT. Share with us your evidence-based protocols and plans of care in the treatment of DVT. Share with us your challenges and successes in implementing this initiative to prevent DVT. I look forward to hearing from you!
References
- American Heart Association. www.americanheart.orgAccessed November 26, 2007
- . Venous thromboembolism epidemiology. Semin Thromb Hemost. 2002;28(suppl 2):3–13
- . Prophylaxis of venous thromboembolism in medical patients. Curr Opin Pulm Med. 2004;10:356–365
- . The epidemiology of venous thromboembolism. Circulation. 2003;107(23 suppl 1):14–18
- . A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol. 2004;93:259–262
- . Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–559
PII: S1062-0303(07)00148-3
doi:10.1016/j.jvn.2007.11.003
© 2008 Society for Vascular Nursing, Inc. Published by Elsevier Inc All rights reserved.
