This potentially very serious complication can often be prevented by assessing patients for risk of VTE and then taking steps to prevent DVT. Reducing VTE decreases the chance of readmission to hospital, serious complications, and death (IHI, 2012).
A Real Case of VTE
In January 2007, Mary B., a 61 year-old working artist, was generally healthy apart from leg pain and limitations due to osteoarthritis of her hips and knees. After years of progressive pain and a carefully considered decision, Mary decided to undergo knee arthroplasty. She had a very positive attitude going into the surgery. Unfortunately, Mary developed major bilateral pulmonary emboli a few days after hospital discharge. Although Mary was prescribed low doses of warfarin after surgery, it was given for only five days and she never achieved the target INR range.
"I became what the Sheps/Cardiff Report (2004) to Health Canada would refer to as a near miss in their critical report on the profound 'lack of safety management culture in healthcare," says Mary.
Given that the most common serious complication after major orthopaedic surgery is deep vein thrombosis and pulmonary emboli, Mary believes that the hospital where she had surgery has a "serious systemic blind spot in understanding PE which puts any patient at high risk."
Mary's marked shortness of breath and chest pain slowly resolved over several weeks after starting anticoagulant therapy. She "felt alone in trying to understand the cause" of her distressing symptoms and why better thromboprophylaxis was not used in her case. She is now reluctant to have more surgery because of her near fatal event.
Mary hopes that healthcare providers will take a serious "step towards a healthier and safer public environment" by understanding the risks for deep vein thrombosis and PE and providing appropriate thromboprophylaxis.