الفهرس 
EPIDEMIOLOGY OF VENOUS THROMBOEMBOLISMOnly 14 pages are availabe for public view
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Abstract
Venous thromboembolism (VTE) is a leading cause of hospital-related
deaths worldwide. However, the proportion of patients at risk of VTE who
receive appropriate prophylaxis in Egypt is unknown. Venous
thromboembolism (VTE), including deep venous thrombosis (DVT) and
pulmonary embolism (PE), is a common and severe complication of critical
illness Among the general medical ICU population, the incidence of DVT
ranges between 13% to 24% in the first week of admission, PE is one of the
three most frequently underdiagnosed illnesses identified during autopsies.
Autopsy studies detected PE in 7 to 27 % of critically ill patients; of these,
only one-third were clinically suspected.
ICU patients share similar general risk factors for VTE with other
patients as: age, immobilization, obesity, past history of personal or familial
VTE, past history of neoplasm, sepsis, stroke, respiratory or heart failure,
pregnancy, trauma, or recent surgery. Additional, specific risk factors for the
ICU population have also been described as: Mechanical ventilation, central
venous catheterization, platelet transfusion and vasopressor administration.
Venous thrombus formation and propagation is associated with one or
more of the following elements, collectively known as Virchow’s triad:
venous stasis, blood vessel wall trauma or abnormality and increased risk of
blood coagulation.
A venous thromboembolism (VTE) prevention protocol is a standardized
VTE risk assessment linked to a menu of appropriate VTE prophylaxis
options for each level of risk. This protocol provides guidance for
management of patients with contraindications to pharmacologic prophylaxis.
Bleeding risk tools and guidance for the timing of administering anticoagulant
prophylaxis around surgical procedures or other high bleeding risk intervals
should also be part of a protocol.
Having identified which patients are at risk of venous thromboembolism,
the next choice for the physician is to select the most appropriate prophylactic
measure for the patient circumstances. The ideal primary prophylactic should
be effective, free from clinically important side effects, and well accepted by
patients, nurses and medical staff. It should be easy to administer, relatively
inexpensive and require minimal monitoring. There are two general types of
prophylaxis: mechanical and pharmacological, Anticoagulants are the corner
stone in both prevention and treatment of VTE.
Root cause is defined as the most basic reason for undesirable condition
which, if corrected, would have prevented it from existing. So Root cause
analysis (RCA) refers to the process to identifying these casual factors. Root
cause analysis initially developed to analyze Industrial accidents, now in
medicine RCA is widely deployed as a cause analysis tool in health care
Root Cause Analysis explores the how, the what and most importantly
the why of patient safety incidents. The technique uses a structured process to
move beyond identifying what went wrong and helps identify the contributory
factors and root causes of patient safety incidents using a number of tools and
techniques.
Organizations are required to investigate all inpatient VTE events using
root Cause analysis methodology where specific questions can be posed
which relate to VTE risk assessment, prophylaxis and patient involvement,
eventually allows them to actively learn from venous thromboembolism
incidents and improving patient safety.
The studies show low levels of VTE knowledge existed throughout the
system. No one felt directly responsible for VTE risk assessment or for
putting an action plan based on the risk assessment. Here comes the role of
root cause analysis.
By applying RCA it highlights the importance of continuous training,
risk assessment to prevent VTE and to understand the significance of the
procedure to ensure that VTE preventative measures are administered also it
is essential that medical staff acknowledge that VTE prevention is the
responsibility of everyone involved in a patient’s care.