DVT question...

[deleted9493]

---

Members don't see this ad.

Hey guys, my dad has multiple sclerosis of a pretty progressive variety and has, over the past 14 years or so, degenerated to the point where he's quadriplegic. Why is it that in spite of being completely immobile there is no concern of thrombotic/embolic events? Is the lack of muscle pumping in his legs both causative of his edema and preventative in terms of dvt formation? Is the lack of venous endothelial compromise the reason? What's going on?

I really do appreciate your feedback and I apologize if this is menial material for this forum...I'm just a curious second year. Thanks!

 

[Idiopathic]

Are you saying that because he isnt being prophylaxed against DVT that there must not be a concern? I would not necessarily agree with this. Thrombosis is a risk, but not a guarantee, and if he has never had a thrombotic event, then it is probably not necessary to rx him to prevent one at this time. I would think that compression stockings/TED hose would be indicated however. There is nothing special about his condition that would make a DVT less likely, per se.

Anyone else?

 

[deleted9493]

Sorry, I wasn't trying to convey that I personally thought him to be without risk for dvt. My inclination is to believe that he would be predisposed but I haven't really heard much about thrombotic events in the physically disabled, whereas in the postoperative patient, it's one of the more significant complications. If not due to immobility, what accounts for the difference?

 

[Idiopathic]

I think its probably because you are much more likely to encounter the post-op/immobilized patient in the hospital. Anyone who is immobilized is at risk for DVT. Initial rx for someone who is clot-naive is the compression hose, etc. I dont believe they heparinize/lovenox people who have never had a clot, unless they are extremely high risk. Again, Im not sure, but i concur that he would be at risk.

 

[Idiopathic]

oops

 

[aredoubleyou]

As I recall all immobilized pts are at risk for dvt, regardless of eitiology. I doubt that there is any protective effect that he has that would lower his risk. Surgery is independent risk fatcor for dvts, and immobility only exacerbates that risk. Most immobilized people do not get dvts all though the risk is far higher. There are few medical interventions for dvt prophylaxis. Lovenox is very expensive and i doubt an insurance company would pay. Blood thining meds have lots of side effects where the risks may outweigh the benefits in the case where someone is only at risk for dvt.

Thats my 2 cents

 

[Idiopathic]

As I recall all immobilized pts are at risk for dvt, regardless of eitiology. I doubt that there is any protective effect that he has that would lower his risk. Surgery is independent risk fatcor for dvts, and immobility only exacerbates that risk. Most immobilized people do not get dvts all though the risk is far higher. There are few medical interventions for dvt prophylaxis. Lovenox is very expensive and i doubt an insurance company would pay. Blood thining meds have lots of side effects where the risks may outweigh the benefits in the case where someone is only at risk for dvt.

Thats my 2 cents

I dunno, aspirin is pretty cheap and probably more effective than we realize against DVT. Evidence is sketchy, but without a clear contraindication to ASA, how could you not take one a day to help prevent clots?

 

[AJM]

Actually, quadriplegics and paraplegics are not at any higher risk for DVT than the general population as long as they are not acutely ill. There have been some studies in the past that have demonstrated this -- I don't remember which journals they were in off-hand. It's my understanding that it is not clear why it is that quads don't get DVT's. A theory I've heard tossed around is that the difference between quads and, say, post-op patients, is that quads do not have any underlying inflammatory process going on which may be an important contributor to clot formation. This is all assuming that the quad does not have any active infection, surgical issue, or other sort of thing that could increase their risk for VTE.

 

[militarymd]

Actually, quadriplegics and paraplegics are not at any higher risk for DVT than the general population as long as they are not acutely ill. There have been some studies in the past that have demonstrated this -- I don't remember which journals they were in off-hand. It's my understanding that it is not clear why it is that quads don't get DVT's. A theory I've heard tossed around is that the difference between quads and, say, post-op patients, is that quads do not have any underlying inflammatory process going on which may be an important contributor to clot formation. This is all assuming that the quad does not have any active infection, surgical issue, or other sort of thing that could increase their risk for VTE.

bingo....stress, SIRS, trauma, surgery....adds onto to underlying risk.

 

[ThinkFast007]

Actually, quadriplegics and paraplegics are not at any higher risk for DVT than the general population as long as they are not acutely ill. There have been some studies in the past that have demonstrated this -- I don't remember which journals they were in off-hand. It's my understanding that it is not clear why it is that quads don't get DVT's. A theory I've heard tossed around is that the difference between quads and, say, post-op patients, is that quads do not have any underlying inflammatory process going on which may be an important contributor to clot formation. This is all assuming that the quad does not have any active infection, surgical issue, or other sort of thing that could increase their risk for VTE.

this guy seems to be correct.

to the original poster....look up something called VIRCHOW's TRIAD. believe me you will get asked this as a third year med student.

Virchow's Triad is a fairly good synopsis of the risks for DVT. One of the words is "endothelial injury". Despite what surgeons may think, surgery is trauma='endothelial injury'...this is one of the reasons why they are at incr risk for DVT. Your father would have one of the risks, something called "stasis". 👍

 

[Idiopathic]

this guy seems to be correct.

to the original poster....look up something called VIRCHOW's TRIAD. believe me you will get asked this as a third year med student.

Virchow's Triad is a fairly good synopsis of the risks for DVT. One of the words is "endothelial injury". Despite what surgeons may think, surgery is trauma='endothelial injury'...this is one of the reasons why they are at incr risk for DVT. Your father would have one of the risks, something called "stasis". 👍

I think everyone would agree that immobility is a risk factor for DVT, and to top it off, this individual has an inflammatory neurological condition with an unknown systemic component. It would be very short-sighted to say that this man is not at any higher risk for DVT than the general population, who, just for starters, do not have venous stasis. I dont think ASA and TED hose would be too much to ask. Id certainly do it.

 

[Magnus67]

I dunno, aspirin is pretty cheap and probably more effective than we realize against DVT. Evidence is sketchy, but without a clear contraindication to ASA, how could you not take one a day to help prevent clots?

There appears to be a lot of truth in this, I was at a Drug Rep Dinner(free steak woot!) where one of the studies was presented that compared aspirin, Plavix, and aspirin + Plavix for STROKE prevention. There was no appreciable difference in either therapy. One doctor asked about DVT prophylaxis, and the hasnt been a a head to head study for DVT. This guy was pushing Aggrenox by the way. It seem just because we have all these Platelet ADP, 2a\3b inhibitors, 350mg of apsirin may be nearly as effective. Hopefully more studies are done, but no body wants their new "wonder drug"
to be outdone by aspirin.

By the way Aggrenox is about $122 a month, aspirin is about $12 a month, a daily injection of Lovenox about $250 for two weeks, and Plavix is $117 a month.

 

[Idiopathic]

I dont think any super strong studies of ASA as prophylaxis in intermediate-risk DVT patients has been done. It makes perfect sense to me, especially if you cant progress the patient to ambulation.

 

[foxtrot]

When a pt goes under general anesthesia is there a certain time frame where a pt has a higher risk for DVT? I had heard that during induction there is a high risk since you are predisposing pt to a low flow state but I don't have any evidence to back this up. Any of the veterans have any comments on this?