Venous thromboembolism: pharmacological and nonpharmacological interventions

Abstract

The formation of blood clots is a significant threat to individuals with limited mobility, whether in the hospital or recovering in an outpatient setting. Prevention of deep vein thrombosis and pulmonary embolism has been found to be cost-effective when compared with treating an existing thrombosis. Despite these positive findings, compliance with the clinical practice guidelines is less than ideal. The National Consensus Standards for the Prevention and Care of Deep Vein Thrombosis Project identified 4 domains to address the problem of noncompliance related to venous thromboembolism: risk assessment, diagnosis, prevention, and treatment.The objective of treating an existing deep vein thrombosis is to prevent further extension of the clot. Pharmacological interventions for both prevention and treatment include unfractionated heparin, low-molecular-weight heparin, selective factor Xa inhibitors, and vitamin K antagonists; nonpharmacological interventions include mechanical measures, such as inferior vena cava filters, graduated compression stockings, and intermittent pneumatic compression devices. Pharmacological interventions interfere with various factors of the coagulation cascade. An adverse effect commonly associated with these drugs is excessive bleeding. The mechanism of action surrounding mechanical interventions is to increase venous return and decrease the risk of pooling of blood in the leg veins. These interventions are effective only if implemented. Clinical application of clinical practice guidelines is imperative to protect patients at risk.