To prevent pulmonary embolism, attention must be paid to reducing individual risk factors. Behavioral risk factors
- Diet
- Inadequate fluid intake – leads to desiccosis (dehydration), thus increasing thrombophilia (tendency to clot/thrombosis)
- Consumption of stimulants
- Tobacco (smoking)
- Physical activity
- Frequent prolonged sitting or immobility (bedriddenness).
- Prolonged sitting in front of the TV – ≥ 5 h/d in front of the TV: twice the risk of developing a fatal pulmonary embolism than people who watch < 2.5 h of TV
- Long-haul flights (“economy-class syndrome”).
- Overweight (BMI ≥ 25; obesity) – overweight from a BMI (body mass index) > 30 – risk increase of 230% due to increase in clotting and inhibition of fibrinolysis – inhibition of the dissolution of blood clots.
Prophylaxis of venous thromboembolism (VTE)
| Operations/Injuries | Drug prophylaxis | Physical prophylaxis | Special features | |
| Abdominal and pelvic surgeries | low risk | none ↑ |
Duration
|
|
| Medium risk | UFH/NMH ↑↑ | IPC/MTPS ⇔ | ||
| high risk | NMH/fondaparinux ⇔ | IPC/MTPS ⇔ | ||
| MIS (minimally invasive surgery) | Recommendations as for open surgery | |||
| Pelvic fractures | See fractures near the hip joint | |||
| Spine (elective surgery) | Individual decision | |||
| Spinal injury | NMH ↑↑ | alternatively IPK ↑ | ||
| Transplant Medicine | NMH/UFH ↑↑ | IPC/MTPS ⇔ | ||
| Arthroscopy with longer operation time and limitation of mobility | NMH ↑↑ | – | ||
| Hip joint replacement (elective surgery) | NMH/fondaparinux/NOAK ↑↑ | IPC/MTPS ⇔ | Duration 28-35 days | |
| Fractures near the hip joint | NMH/fondaparinux ↑↑ | IPC/MTPS ⇔ | ||
| Knee joint replacement (elective surgery) | NMH/fondaparinux/NOAK ↑↑ | IPC/MTPS ⇔ | Duration 11-14 days | |
| Fractures near the knee joint and osteotomies | NMH/fondaparinux ↑↑ | IPC/MTPS ⇔ | ||
| Bone, ankle joint, foot with immobilizing hard bandage | NMH ↑ | IPC/MTPS ⇔ | ||
| Polytrauma | NMH ↑↑ | IPC ↑ | Bleeding risk | |
| Burns | NMH ↑↑ (in the presence of immobilization/additional risk factors). | For larger area UFH i.v. | ||
| Conservative therapy with immobilization across joints in a hard bandage | Prophylaxis in analogy to operated patient ↑↑ | IPC/MTPS ⇔ | Early functional therapy | |
| Contraindications to medical prophylaxis | – | IPC ↑↑ | KI due tobleeding risk, renal insufficiency. | |
Legend
- Degree of recommendation: ↑↑ = strong recommendation, ↑ = recommendation, ⇔ = recommendation open.
- NMH: low molecular weight heparin.
- NOAK (New Oral Anticoagulants): non-vitamin K-dependent anticoagulants.
- UFH: unfractionated heparin.
- IPC: intermittent pneumatic compression
- MTPS: medical thrombosis prophylaxis stockings
Further notes
- After endoprosthetic replacement of the knee or hip joint, low-dose acetylsalicylic acid (ASA; 81 mg; 9 d after knee arthroplasty; 30 d after total hip arthroplasty (TEP)) is no less effective than rivaroxaban (10 mg) in preventing adverse thromboembolic events; follow-up 90 days:
- Venous thromboembolism (VTE) developed in 0.64% of patients receiving ASA and 0.70% receiving rivaroxaban prophylaxis.
- Pulmonary emboli occurred in 0.29% and 0.35% on rivaroxaban prophylaxis, respectively.
- Major bleeding occurred at 1.29% and 0.99%, respectively, with rivaroxaban (p = 0.43)
- Medical thrombosis prophylaxis stockings (MTKS): a randomized multicenter trial of electively operated patients demonstrated that low-molecular-weight heparins (NMH) alone were no less protective against venous thromboembolism (VTE) than NMH plus compression stockings. Limitation: stockings were only knee-high.
Prevention factors (protective factors)
- Medical thrombosis stockings (may-recommend).
- Intermittent pneumatic compression (IPC) – therapeutic procedure for compression treatment of venous and lymphatic diseases. Of crucial importance for the therapeutic effect of the procedure is the so-called alternating pressure massage. That I but I think we have which Willi not straight are yes available I’m sure and how would you because the complaints modest to the typical so purely in principle to both man indication: use for thrombosis prophylaxis at lower risk.The IPK has proven in studies as placebo and thrombosis prophylaxis stockings significantly superior.
