Preventing Deep Vein Thrombosis in Total Knee Replacement Patients

Acute medical and surgical nursing 1
Acute medical and surgical nursing
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Acute medical and surgical nursing 2
Acute medical and surgical nursing
Post operative deep vein thrombosis [DVT]
Introduction
DVT or deep venous thrombosis is the formation of a thrombus in the deep veins. In lower limb,
distal DVT refers to thrombosis in infrapoplitial veins [1] and proximal DVT refers to
thrombosis in poplitial, femoral and iliac veins [2]. At the adductor hiatus, poplitial vein
continues as femoral vein. Adductor hiatus is the distal end of the adductor canal, a canal in the
middle third of thigh, which contains femoral vessels [3]. DVT can be provoked due to an
identifiable cause like trauma, surgery or immobilization or it can be unprovoked, wherein no
environmental cause can be identified [2]. Pulmonary embolism is a potentially life threatening
complication of DVT. The common symptoms of DVT of leg are pain, edema, and warmth [2].
Many patients with DVT are totally asymptomatic and unfortunately, a fatal pulmonary
embolism may be the only presentation of DVT.
DVT following Total knee replacement [TKR]
The incidence of DVT in TKR patients not receiving DVT prophylaxis is 40 to 88%. It is less
than or equal to 1% in patients receiving adequate thromboprophylaxis [2]. Thus there is a very
significant, almost 60% decrease in the incidence of DVT in patients receiving
thromboprophylaxis. 2012 ACCP- American College of Chest Physicians guidelines

Acute medical and surgical nursing 3
recommend pharmacological DVT prophylaxis for all patients undergoing TKR who do not have
excess bleeding risk [4].
Risk factors for DVT
Virchow’s triad consists of slowing or stasis of blood flow, hypercoagulable state of blood and
injury to endothelial lining of blood vessels. It explains the etiopathogenesis of DVT in most
cases [2]. The hypercoagulable state may be inherited or acquired. Factor V Leiden mutation and
prothrombin gene mutation together account for more than half of the cases of inherited
thrombophilias , that is inherited hypercoagulable states.[2]
There are numerous acquired risk factors like surgery, trauma, infection, immobilization etc.
Among surgeries, the risk is more in orthopaedic surgery, neurosurgery and surgery for
malignancies. [2]
The focus of this article is on assessment of DVT risk in a given patient and how to prevent
the occurrence of DVT in a patient of TKR
Various guidelines and scoring systems have been developed to help a clinician in assessing the
risk of DVT and how to prevent it in a particular situation.
The risk of DVT in a given post operative patient not only depends on the patient’s
characteristics but it also depends on the type of surgery and the techniques used in the surgery.
Patient related factors