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The surgeon general issues a call to action to prevent pulmonary embolism and DVT

Posted Dec 10, 2008 at 02:23 PM, EDT by Samuel Goldhaber

The U.S. Surgeon General has just issued a 42-page Call To Action To Prevent Pulmonary Embolism and DVT.  He cites the latest epidemiologic studies, risk factors, and cost of PE/ DVT to our society.  He proposes strategies to improve our preventive efforts.  This blog provides links to the Surgeon General’s DVT Workshop, with PowerPoint slides available to you from 21 lectures used in preparing the Call To Action.

Will the Surgeon General’s Call To Action improve the well being of your patients?  Will it increase patient safety?  Will it serve as a successful jumping off point to improve preventive strategies?   Please post your comments and thoughts.

See:

US surgeon general issues "call to action" on DVT and PE

The Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism - 2008 

Surgeon General’s 2006 Workshop on Deep Vein Thrombosis 

Venous Disease Coalition 

North American Thrombosis Forum 

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What risk for PE, DVT is there in a patient with a 4 cm  Infra Renal aortic aneurysm with peripheral mural thrombus. Pt is a 71 year old with severe bulllous Emphysema, (+) CAD, (+) hyperlipidemia, and no hx of PE or DVT. PT is on ASA and Plavix s/p Cardiac stenting. Is there a role for anti-coagulation in these patients?
Posted by Susan Morris, Feb 04, 2009 Publié le Susan Morris, 02.04.2009
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Risk/benefit...patient at increased risk for VTE due to her age and I would assume immobility.  ASA and clopidogrel will not prevent a VTE.  Pt could benefit from warfarin for the mural thrombus but would really increase the risk for bleeding.  Warfarin should not be substituted for anti-platelet therapy.  Evidence demonstrates that anticoagulation is inferioir NEJM 1999 Schomig...all I remember of that citing.  VTE is one of the more preventable adverse events in the hospital setting.  Under appreciated in my opinion.  Look for it to becoming a never event from CMS in the near future. 
Posted by David C, Feb 05, 2009 Publié le David C, 02.05.2009
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Thank you for your comments. I forgot to include that patient is on a PPI as well as Plavix and with the recent studies implying that PPI's interfere with the anti-platelet benefits of Plavix, would Coumadin be an appropriate anti-emoblic measure (in a patient with an abdominal mural thrombus)?

Are there any studies that have been done evaluating possible increased risk for embolic pathology (DVT, PE)  in patients who have abdominal aortic aneurysms with a mural thrombus ?

 

 


Posted by Susan Morris, Feb 08, 2009 Publié le Susan Morris, 02.08.2009
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Who's Talking
Samuel Z Goldhaber, MD
Professor of Medicine
Harvard Medical School
Director, Venous Thromboembolism Research Group
Co-Director, Anticoagulation Management Service
Cardiovascular Division
Brigham and Women's Hospital
Boston, MA