Risk of venous thromboembolism in immobilized patients

Discussion

Gaspard et al. (2015, pp. 1, 2, 3, 5) carried out a study to compare chemical to mechanical prophylaxis in the prevention of VTE in nonsurgical patients on mechanical ventilation. The researchers carried out a retrospective study using data for non-surgical ICU admissions with mechanical ventilation in Cooper University Hospital from the year 2002 to 2010. Data corrected include demographic information, comorbidities, and outcome of hospital stay and patients categorized in those receipt of chemoprophylaxis or mechanical prophylaxis. After evaluation of total patients, 748 met the inclusion criteria; 329 were treated pharmacologically and 419 using mechanical means. Univariate and multivariate regression analysis indicated that patients treated with pharmacological means had reduced risk of developing VTE. Study results showed that 14 patients developed VTE while in ICU where only 1 on chemical prophylaxis was involved and 13 had been on mechanical prophylaxis. The limitation of the study was it retrospective nature which could not provide the specific proof for the specific VTE in the evaluated patients.

In another study, Pontelli et al. (2012, pp. 79, 80, 84) aimed to evaluate the effectiveness of chemical to mechanical prophylaxis in patients who had undergone consecutive abdominoplastic surgery over a period of three years. A total of 563 patients were reviewed in the retrospective study where 357 had received enoxaparin and 206 received mechanical prophylaxis. Data analysis was carried out using IBM SPSS version 19 in a two-tailed test and level of significance at p < 0.05. Study results show a 0.6% incidence of VTE in chemical treatment and 0.5% in the patients who received mechanical treatment. The study thus concluded that despite the facts that factors such as smoking, obesity, and the number of surgical procedures, chemical, and mechanical methods were equally effective in the prevention of VTE. The study limitation was that all patient factors were not constant as the number of operations, obesity, and smoking which could have affected the occurrence of VTE despite preventive measures.

Gharabaghi and Meshkini (2015, p. 32) study was aimed at comparing the effectiveness of chemical and mechanical prophylaxis for deep venous thrombosis in patients with spinal cord injury. The 75 sample patients in the double-blind clinical trial study were divided into three groups. The first groups received enoxaparin with compression stocking, the second heparin, and stockings, while the third only received compressive stockings. Results indicate 12% incidence of DVT in the first group, 4% in the second, and 4% in the third group. The study concluded that there were no significant differences in the effectiveness chemical and mechanical methods. One of the limitations of the study is that it did not purely compare each single method independently.

Sobieraj-Teague et al. (2012; pp. 229, 230, 231) randomized study on 150 patients was aimed at assessing tolerability and efficacy of calf compression devices, venowave. A total of 75 patients were prescribed with venowave while 75 were control patients. Study results occurrence in 1% and 18.7% respectively. The study concluded the effectiveness of venowave, a mechanical method of preventing VTE. In another multicenter, double-double randomized control trial by Robinson et al. (2014, PP. 2 – 9), the effectiveness of enoxaparin 1mg/kg or 40mg/day control dose in 133 patients in ICU with acute kidney injury. Study results showed an 80% and 40% reduction in the incidence of VTE consecutively. The conclusion of the study indicated the effectiveness of enoxaparin, however, lack of appropriate standard dosage presented a challenge in its effectiveness.

The above studies were quantitative studies aimed at testing the effectiveness of preventive strategies for VTE. The variables were pharmacological, mechanical method, and the patient at risk, immobilized patients in the hospital. Most patient factors were evaluated to ensure constant factors and where information was not available assumptions were made provided the subject passed the inclusion criteria (Grove, Gray & Burns, 2015).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References

Gaspard, D., Vito, K…….Gerber, D. (2015). Comparison of Chemical and Mechanical     Prophylaxis of Venous Thromboembolism in Nonsurgical Mechanically Ventilated Patients. Thrombosis, 2015: 1 – 6.

Gharabaghi, M. & Meshkini, A. (2015). A Comparison of pharmacologic and mechanical prophylaxis on the prevention of deep vein thrombosis in spinal cord injury. Trauma    monthly, 20(Special Issue): e28508.

Grove, S., Gray, J. & Burns, N. (2015). Understanding nursing research. Building an        evidence – based practice. Maryland heights, MO. Elsevier Saunders.

Pontelli, E., Scialom, J., Dos, T. & Pontelli2, S. (2012). Pharmacologic and intermittent      pneumatic compression thromboembolic prophylaxis in 563 consecutive        abdominoplasty cases. Revista Brasileira de Cirurgia Plástica, 27(1): 77 – 86.

Robinson, S., Zincuk, A., Larsen, U. Ekstorm, C. & Toft, P. (2014). A feasible strategy for           preventing blood clots in critically ill patients with acute kidney injury (FBI): study   protocol for a randomized controlled trial. Trials, 15(226): 1 – 10.

Sobieraj-Teague, S., Hirsh, J., Yip, G……..Eikelboom, J. (2012). Randomized controlled trial of a new portable calf compression device (Venowave) for prevention of venous    thrombosis in high-risk neurosurgical patients. Journal of Thrombosis and          Haemostasis, 10(2): 229 – 235.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s


%d bloggers like this: