A Comparison of Low Dose Heparin and Venous Foot Pumps in the Prevention of Venous Thromboembolism.
Background and purpose: Venous thromboembolism (VTE) is a disease that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). It is a common, lethal disorder that affects both hospitalized and nonhospitalized patients, if overlooked, can lead to long-term complications. VTE results from a combination of hereditary and acquired risk factors. Vessel wall damage, venous stasis, and increased activation of clotting factors also known as the Virchow triad is the most common cause of VTE mainly DVT. According to the National Institute of Health on the consensus of prevention of pulmonary embolism, all hospitalized patients are to be stratified into low, moderate, high and highest risk levels and treated according to their level of risk. Surgical patients, especially hip and knee patients are classified as highest risk while patients under the age of 40 with minor surgeries lasting less than 30 minutes are considered low risk patients. The preferred form of prevention of VTE in the low risk group is early active mobilization while a combination of pharmacological and mechanical management is recommended for the highest risk group. In this review, we will focus on the effectiveness of Low Molecular Weight Heparin (LMWH) compared to pneumatic compression devices in the prevention of VTE in very high risk hip and knee surgical patients. PICO Summary: The population included in this review comprised of surgical patients with hip and knee surgery. The intervention examined was the use of LMWH and pneumatic compression devices. The comparison is LMWH versus pneumatic compression devices and the outcome measured is VTE. Hence the question, in patients undergoing hip and knee surgery, does the use of LMWH, compared to pneumatic compression devices, reduce the rates VTE. Significance: According to the Center for Disease Control, one of the most common causes of death in the hospitalized patient is PE. Although the precise number of people affected by PE and DVT is unknown, an estimated number of 300 000 to 600 000 of PE and DVT cases are reported annually in the United States. Routine autopsies estimate that 10-25% of hospital deaths are caused by PE, many of which are extensive enough to be the major cause of death in these patients. According to the UMASS Medical School Center for Outcome research, 80% of PE are silent, over 60% of deaths resulting from PE occur within the first 2 hours and 1 in 100 hospitalized patients dies from a PE. Research has also shown that PE remains the most common cause of preventable deaths in hospitalized patients. The UMASS Medical School Center for Outcome Research also reports that over 90% of PE originates from DVT with 50% of PE and over 60% of DVT being preventable. Hence, the National Institute of Health recommends a more extensive use of prophylaxis treatment in the prevention of DVT and PE especially in high and highest risk patients. However, the major challenges to preventing PE and DVT are effectively predicting which individuals are at risk and ensuring appropriate access to standards of care for these individuals. Evidence Review
Search strategy: From the PICO process we conduct a systematic literature review using key terms from our topic. The literature search was conducted through CINAHL, MEDLINE and OVID. Key terms used for the search were pulmonary embolism, deep vein thrombosis, and post surgical patients. The original search of the PICO question did not relieve sufficient information. The PICO question was revised and key terms were entered into the data bases which revealed more research articles. A combination of these search terms produced a narrower search result consisting mainly of systematic reviews and meta-analysis. Randomized control (primary) studies were then selected from...