Claire Dawson
Deep vein thrombosis (DVT) is a blood clot in a vein, usually in the leg. It can be life-threatening because blood clots can travel to the lungs, causing a pulmonary embolism (PE), which may result in death. Hospitalized patients are at an increased risk of developing DVT, with an absolute risk of 10-20% among general medical patients and up to 40-80% in patients undergoing hip or knee surgery, or experiencing major trauma. Therefore, it is crucial to take preventive measures to reduce the likelihood of DVT during a hospital stay. This includes the use of blood-thinning medications, compression stockings, and early mobilization with simple exercises to improve circulation.
| Characteristics | Values |
|---|---|
| Risk factors | Surgery, trauma, immobilisation, malignancy, use of oestrogens, heart or respiratory failure, and smoking |
| Preventative measures | Blood-thinning medicines, e.g. heparin, enoxaparin, warfarin, rivaroxaban, or aspirin |
| Compression stockings | |
| Sequential Compression Devices (SCDs) | |
| Intermittent pneumatic compression (IPC) | |
| Ankle exercises | |
| Walking |
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What You'll Learn
Wear compression stockings to improve blood flow
Compression stockings are a type of specialised sock that applies gentle pressure to your legs and ankles. They are tighter than average socks and help to keep blood flowing toward your heart by preventing it from pooling and forming blood clots. They also help to reduce pain and swelling.
Compression stockings are available in different lengths and pressures, depending on your needs. For deep vein thrombosis (DVT), they usually go just below the knee, but you can also get thigh-highs and waist-length tights. They also come in different levels of pressure, measured in mmHg (millimeters of mercury). Stockings rated 20 mmHg or higher require a prescription.
If you are wearing compression stockings, make sure they are smooth and lie flat against your skin, avoiding bunching. Do not fold or roll the tops down, as this can cause a tourniquet effect, blocking or slowing your blood flow. You can wear socks, slippers, and shoes over your compression stockings.
Compression stockings are generally safe to wear for a few hours, and prescribed stockings can be worn all day and sometimes all night. You should follow the instructions given by your healthcare provider. If you experience skin changes, such as redness, irritation, or infection, you should talk to your provider right away.
Compression stockings are beneficial for many conditions. They are often recommended for managing orthostatic hypotension, or low blood pressure when standing up after sitting down for a period. Athletes sometimes wear compression socks during workouts or competitions to improve blood flow and oxygen delivery. Compression stockings can also help pregnant women prone to swelling in their legs, feet, or ankles, as well as individuals who are confined to a wheelchair.
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Take blood-thinning medication
Blood-thinning medications are often prescribed to prevent deep vein thrombosis (DVT) in hospitalised patients. DVT is a blood clot that forms in a deep vein, usually in the leg, but it can also occur in the arm or other parts of the body. These blood clots can be life-threatening, especially if they travel to the lungs, resulting in a pulmonary embolism (PE), which is a medical emergency.
To prevent this, doctors may prescribe blood-thinning medications, also known as anticoagulants, such as heparin, enoxaparin (Lovenox), warfarin, or rivaroxaban. These medications work by reducing the ability of the blood to clot, thereby decreasing the likelihood of DVT formation. It is important to follow the directions provided by your healthcare provider when taking these medications and to be aware of any potential interactions with food or other medicines.
In addition to blood-thinning medications, doctors may also recommend mechanical methods to prevent DVT. This includes the use of compression stockings, which are tight-fitting elastic stockings that apply pressure to the legs, improving blood flow back to the heart and preventing blood from pooling and forming clots. Compression devices, such as Sequential Compression Devices (SCDs), are another mechanical method to prevent DVT. SCDs involve plastic sleeves wrapped around the legs that are connected to a pump that inflates and deflates the sleeves, gently squeezing the legs or feet to improve circulation and prevent clots.
Blood-thinning medications are often used in conjunction with mechanical methods to effectively prevent DVT in hospitalised patients. The choice of medication and prophylaxis method depends on the patient's individual risk factors and needs, which should be assessed by a healthcare professional. It is important to note that while blood-thinning medications can help prevent DVT, they may also come with an increased risk of bleeding, so careful consideration and monitoring are necessary.
Overall, taking blood-thinning medication is an essential strategy to prevent DVT in hospitalised patients, reducing the risk of blood clots and potentially life-threatening complications. However, it should be complemented by other measures, such as mechanical prophylaxis, to ensure comprehensive DVT prevention.
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Do simple exercises to improve circulation
Doing simple exercises is a great way to improve circulation while in hospital. Walking is an effective way to get your blood pumping, and it can be done anywhere and at any time. It doesn't matter if you are walking through the park or just around the block, or even in a hospital corridor. The more muscle contraction in your legs, the better the blood flow in your limbs and throughout your body.
Yoga is another low-impact form of exercise that is easy to modify for beginners and can be done anywhere. It involves bending, stretching, twisting, and deep breathing exercises. These movements can help compress and decompress veins, improving circulation and boosting lung capacity. A simple yoga position for beginners to try is the downward-facing dog. This helps improve circulation by putting the hips and heart above the head, allowing gravity to increase blood flow toward the head.
You can also try some simple exercises while resting in bed or sitting in a chair, such as moving your feet in a circle or up and down. Do this 10 times an hour to improve circulation. Another simple exercise is diaphragmatic breathing. Lying down, put one hand on your belly and one hand on your chest. Breathe in, attempting to raise the hand on your belly, without the hand on your chest rising. This means you are using your diaphragm more fully as you breathe.
Doing these simple exercises will help to get your blood pumping and improve circulation while in hospital.
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Use a sequential compression device (SCD)
Sequential compression devices (SCDs) are worn on the lower extremities of patients at high risk for deep vein thrombosis (DVT) to reduce the rate of DVT. SCDs are plastic sleeves wrapped around the legs that are connected to a pump that inflates and deflates the sleeves. The sequential pattern of compression involves the chambers of the extremity garment being sequentially inflated from ankle to knee or mid-thigh, with a maximum pressure of 45-50mm Hg at the ankle, 35 mm Hg at the calf, and 30mm at the thigh. The compression lasts for 11 seconds with a 60-second relaxation period between compressions.
SCDs are widely accepted to be effective in reducing the rate of DVT, and they are believed to work by increasing mean and peak femoral vein velocity and affecting systemic coagulation and fibrinolytic mechanisms. However, the exact mechanism of action of SCDs is not yet known, and clinical studies demonstrating their effectiveness in trauma patients are limited.
SCDs should not be used in cases of DVT, compartment syndrome, extremity deformity, or an open infected wound of the extremity. When using an SCD, it is important to remove the sleeve every 8 hours to assess skin integrity and neurovascular status, checking for the "5 Ps" of ischemia: pain, pulse, pallor, paresthesia, and paralysis.
SCDs are one of several mechanical compression therapies that can be used to prevent DVT, along with compression stockings and intermittent pneumatic compression (IPC).
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Follow tailored prophylaxis instructions from a doctor
Patients admitted to the hospital are at an increased risk of developing deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is the formation of a blood clot in a deep vein, usually in the leg, but it can also occur in the arm or another part of the body. PE, on the other hand, is when a blood clot travels to the lungs, and it is a medical emergency that can lead to death. Therefore, it is crucial to take preventive measures to lower the chances of developing DVT and, consequently, PE.
Doctors will assess your individual risk factors and provide tailored prophylaxis instructions to help prevent DVT during your hospital stay. It is important to follow these instructions carefully to reduce your risk of developing blood clots. Here are some measures that your doctor may recommend as part of your tailored prophylaxis plan:
- Blood-thinning medications: Also known as anticoagulants, these medicines help prevent blood clots from forming. Examples include heparin, enoxaparin (Lovenox), warfarin, and rivaroxaban. Your doctor will prescribe the most suitable option for you based on your health condition and risk factors.
- Compression stockings: These are special elastic stockings that fit tightly around your legs. They apply pressure to help improve blood flow back towards your heart, preventing blood from pooling and forming clots. Your healthcare provider will instruct you on how often to wear them and for how long.
- Exercises: Simple exercises, such as ankle exercises or moving your feet in circles or up and down while resting in bed or sitting in a chair, can improve circulation and prevent blood clots. Your doctor or nurse may recommend specific exercises and advise you on how often to perform them.
- Sequential compression devices (SCDs): These involve wrapping plastic sleeves around your legs, which are then connected to a pump that inflates and deflates the sleeves. This gentle compression helps improve blood flow and prevents clots. Your doctor may advise you on the frequency and duration of using SCDs.
- Returning to activity: Increasing your activity levels improves blood flow and helps prevent clots. Your healthcare team may provide instructions on gradually resuming activities and the types of activities that are safe for you.
Remember, it is essential to closely follow the prophylaxis instructions provided by your doctor. They will assess your individual needs and risks and develop a plan to help prevent DVT during your hospitalisation.
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Frequently asked questions
Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein, usually in the leg. It can be life-threatening when the blood clot travels to the lungs, which is called a pulmonary embolism (PE).
Hospitalised patients are at an increased risk of developing DVT due to venous stasis, so it is important to take preventive measures. The use of compression stockings or devices can help improve blood flow and prevent blood from pooling and forming clots. Anti-clotting medications such as blood thinners or anticoagulants are also commonly used to prevent DVT. Staying active and doing simple exercises while resting in bed can further help to prevent blood clots by improving circulation.
Some commonly prescribed medications to prevent DVT include heparin, enoxaparin (Lovenox), warfarin, and rivaroxaban. These medications are typically administered via injection and work by thinning the blood to prevent clot formation.
