Prophylaxis of DVT

There are numerous factors that contribute to increasing your risk of developing a VTE, either a deep vein thrombosis or a pulmonary embolus They can be related to having a surgical intervention Being immobile when either on a long-haul flight or a long car journey Can be related to obesity or to an underlying medical condition such as cancer if we take people initially one of the key ways is obviously not to be overweight if you're going and looking at ways of addressing being overweight however if you are being admitted to hospital and undergoing a surgical procedure you are at an increased risk of developing a deep vein thrombosis. When you are admitted to hospital you will be asked a series of questions which are part of a risk assessment score to determine your own personal risk of developing a deep vein thrombosis. If you are deemed to be at a certain risk of having a deep vein thrombosis you may be offered various prophylactical measures such as the use of stockings to prevent a deep vein thrombosis or the administration of various drugs such as low molecular weight heparin to again to reduce your risk of having a deep vein thrombosis. If for example you're looking at patients who have known cancer, for example, we normally do not treat them with prophylactic medicines to reduce their risk of developing deep vein thrombosis. There are some exceptions to this with some forms of blood cancer where you may give people some form of prophylactic medication. So what's very important is that there are a variety of factors that can be used to reduce your risk of getting a deep vein thrombosis and pulmonary embolism, but that you discuss this with your healthcare professional. Are there any cases where prophylaxis is contraindicated? There may be various types of prophylaxis that are contraindicated. For example, if you have a patient with peripheral arterial disease, i.e. there are blocks in the arteries such that blood isn't getting to the legs, is contraindicated to use the standard form of TED stockings which are graduated compression stockings which reduce your risk of developing a deep vein thrombosis. Another area in which prophylaxis may be contraindicated is if you have disease of the liver which gives rise to abnormal clotting it may be that you it is contraindicated for you to take drugs to reduce your risk of getting a deep vein thrombosis. One of the other areas where drugs may be contraindicated is if you have got an injury either to the brain or to the spinal cord that if you were to give somebody blood thinning medicines that may cause them to actually get a bleed into the brain or around the spinal cord which could end up with a neurological complication. In this cohort of patients we often advocate rather than giving them drugs using some form of mechanical thromboprophylaxis, either in the way of graduated compression stockings, pneumatic compression or neuromuscular stimulation. So that gives you a flavour of some of the areas where prophylaxis has to be tailored to the individual patient. One of the other controversial areas is the role of IVC filters, which is where an umbrella-like object is inserted into the main vein in the abdomen to prevent clots going to the lungs. There are very few absolute indications for the use of IVC filters in prophylaxis. The two areas that should be considered are those patients in major trauma who cannot have any other form of prophylaxis and there is some indication that they can be used in pregnancy. many guidelines that exist on this but certainly overall the majority of patients do not need to have a filter inserted for prophylaxis. Again this is something that needs to be discussed with your healthcare professional and the balance of your risks of VTV or the risks of insertion of a filter need to be considered. And finally can you still get a DBT even if you're taking prophylaxis? Yeah the simple answer to that question is yes all of the prophylactic issues do is reduce your risk of having a deep vein thrombosis. Thank you.