Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant health concern for hospitalized patients, with an estimated annual rate of 350,000 to 600,000 cases in the United States¹. It is a leading cause of preventable hospital death and one of the most frequent reasons for hospital readmissions following surgery.
As a result, VTE prevention is considered one of the most critical interventions that directly affects patient safety and the overall cost of care². Even though as many as 70% of healthcare-associated VTE cases are preventable, fewer than half of hospitalized patients receive preventative measures³.
This blog explores the dual approach to VTE prevention, focusing on the role of pharmacological and mechanical prophylaxis and when to use each based on established clinical guidelines, studies, and risk stratifications.
Understanding VTE Prevention Strategies
VTE prevention strategies are typically divided into two main categories:
- Pharmacological prophylaxis: The use of anticoagulant medications to inhibit blood clotting.
- Mechanical prophylaxis: Using techniques to promote blood flow, such as intermittent pneumatic compression (IPC) devices and early ambulation strategies.
Pharmacological Prophylaxis
Pharmacological prophylaxis is effective and appropriate for patients at high risk of developing a blood clot but also carries the potential for bleeding complications. This may make them less suitable for patients at moderate or low risk for clotting issues.
Bleeding risk varies with individual patient factors, such as age, bleeding history, kidney function, and the specific medication used.
Mechanical Prophylaxis
Mechanical prophylaxis is an integral part of VTE prevention, and unlike anticoagulant medications/blood thinners, mechanical methods decrease the risk of blood clots without increasing bleeding risk. It is also beneficial when pharmacological options are contraindicated, such as in patients with a high bleeding risk or in lower-risk patients who may not need anticoagulant medication. Intermittent Pneumatic Compression (IPCs) devices are a widely accepted method for preventing DVTs.
The Benefits of Combination Therapy
Mechanical prophylaxis is regularly recommended for use in combination with pharmacologic prophylaxis to reduce the incidence of VTE, particularly in surgical patients. Clinical guidelines such as the Association of Perioperative Registered Nurses (AORN) Guideline for Prevention of Venous Thromboembolism recommend tailoring prophylaxis based on risk levels, supporting combined approaches in high-risk groups.
These guidelines recommend that VTE protocols be evidence-based and include a standardized VTE risk assessment tool, such as the Caprini Risk Assessment Model, a widely used and extensively validated tool for evaluating VTE risk. Furthermore, AORN guidelines recommend clinical decision support for evidence-based VTE prophylaxis based on the level of risk and bleeding at critical phases of care.
For example, AORN guidelines support the use of mechanical prophylaxis with IPC over no prophylaxis; they also support the use of mechanical prophylaxis with IPC over pharmacology prophylaxis alone in surgery patients at risk for VTE. Additional research from the American Society of Hematology guidelines for management of venous thromboembolism states that mechanical methods may be preferred over pharmacological prophylaxis for patients considered at high risk of bleeding. For those considered at high risk for VTE, combined prophylaxis is preferred over mechanical or pharmacological prophylaxis alone.
The chart below illustrates that mechanical prophylaxis is recommended across nearly every risk category for patients with average and high bleeding risk.
Figure 2. Venous Thromboembolism (VTE) Prophylaxis Based on VTE Risk and Bleeding Risk
Source: AORN Guideline for Prevention of Venous Thromboembolism
Additionally, key recommendations outlined in the AORN guidelines include:
- Use portable, battery-operated mobile compression devices to increase patient compliance and mobility.
- Ensure IPC devices can record wear time to monitor adherence.
- Encourage early and frequent ambulation or mobilization as a postoperative intervention to prevent VTE.
Exploring Directions for Continued Improvement
A dual approach to VTE prevention, combining pharmacological and mechanical prophylaxis, offers a comprehensive strategy for reducing the risk of VTE in hospitalized patients. By understanding the benefits and limitations of each approach and tailoring prophylaxis based on individual risk factors, healthcare providers can optimize patient outcomes and reduce the burden of VTE.
However, despite the benefits of mechanical prophylaxis, traditional IPC devices have limitations, often leading staff to opt for pharmacological approaches even in mid-to-low-risk patients who may not require medication. Our next blog explores why traditional IPC devices might lead to low compliance and examines potential strategies to reduce reliance on pharmacological approaches and enhance patient outcomes.