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Deep vein thrombosis (DVT) is the formation or presence of a thrombus in the deep veins. DVT occurs mostly in the lower extremities and, to a lesser extent, in the upper extremities. Pulmonary embolism (PE) is an obstruction of the pulmonary artery or its branches by a thrombus (sometimes due to fat or air). The most likely source of thrombus in pulmonary arteries is an embolization from deep veins in the legs. This activity reviews the causes of DVT and highlights the role of the interprofessional team in the prophylaxis against DVT. Objectives: Identify the cause of DVT. Develop strategies to increase compliance with the use of DVT prophylaxis. Apply best practices when emergent and ongoing management in prophylaxis is unsuccessful. Coordinate with the interprofessional team to enhance prophylaxis against DVT and improve patient outcomes. Access free multiple choice questions on this topic.

Deep vein thrombosis (DVT) is the formation or presence of a thrombus in the deep veins. DVT occurs mainly in the lower extremities and, to a lesser extent, in the upper extremities. Pulmonary embolism (PE) is an obstruction of the pulmonary artery or its branches by a thrombus (sometimes due to fat or air). The most likely source of thrombus in pulmonary arteries is an embolization from deep veins of the legs. This occurs in one-third of patients with DVT. Prevention of DVT thereby decreases the incidence of PE, a serious and life-threatening condition. Venous thromboembolism (VTE) includes DVT and PE. DVT is a major preventable cause of mortality and morbidity worldwide. DVT and PE account for 60,000 to 100,000 deaths annually in the United States.[1] Normally, a balance of procoagulant and anticoagulant factors in the blood prevents thrombus formation intravascularly. One or more factors of the triad of Virchow can lead to the formation of DVT. Triad of Virchow Venous stasis (eg, immobility and congestive heart failure) Endothelial injury (eg, surgery and trauma) Hypercoagulability (eg, OCP, cancer, and thrombophilia)[2] Venous stasis is the most crucial factor, but endothelial injury or hypercoagulability increases the risk of DVT. Hospitalized patients are at risk of venous stasis, and with the presence of other factors, they are at increased risk of DVT compared to patients in the community. DVT prophylaxis targets either venous stasis (mechanical methods) or hypercoagulability (pharmacological prophylaxis). Hospitalized patients are at increased risk of developing DVT (approximately 50%), increasing the risk of PE. PE is one of the most common but preventable causes of death in hospitalized patients. Only 50% of hospitalized patients receive DVT prophylaxis. Prevention of DVT in hospitalized patients decreases the risk of DVT and PE, decreasing mortality and morbidity. DVT prophylaxis can be primary or secondary. Primary prophylaxis is preferred, using medications and mechanical methods to prevent DVT. Secondary prophylaxis is a less commonly used method that includes early detection with screening methods and the treatment of subclinical DVT.

Interprofessional teamwork is essential in preventing DVT in hospitalized patients. Good interprofessional communication among attending clinicians, surgeons (for surgical patients), nursing staff, and pharmacists is vital in using the appropriate prophylaxis methods. All hospitals should have a formal strategy that increases compliance with DVT prophylaxis. Nursing is on the "front lines" and is especially important in DVT prophylaxis, as they can spot patients who might be at risk but not receiving prophylaxis and alert the attending clinician. Pharmacists are valuable in consulting regarding appropriate agent selection and dosing based on various factors, including patient parameters and other medications. Open communication among clinicians, nursing, and pharmacy is vital in preventing DVT and successfully managing the condition should prophylaxis fail. The interprofessional approach to care, where all team members are empowered to provide input on the case, is the optimal paradigm in DVT prophylaxis. [Level 5]