Vascular Thromboembolism (VTE)

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Vascular Thromboembolism (VTE)

Clinical Fundamentals
Author Credentials 

Chad Galer, MD, MA
Chief, Otolaryngology-Head & Neck Surgery
Roudebush Veterans Affairs Medical Center
Assistant Professor
Indianapolis, IN

Module Summary

Venous thromboembolism (VTE) is a major cause of morbidity and mortality in hospitalized patients. Understanding of the particular risk factors inherent to patients having otolaryngologic surgery allows for accurate risk stratification and implementation of strategies to minimize this potentially significant complication. This VTE module is designed to provide understanding of the economic as well as patient impact of VTE. Risk factors will be reviewed along with prophylaxis strategies. 

Quality Improvement

Learning objectives

  1. Understand the impact of VTE on health care costs
  2. Know the effect of VTE on reimbursement and grading of healthcare organizations

References

  1. Hennessey P, Semenov YR, Gourin CG.  The effect of deep venous thrombosis on short-term outcomes and cost of care after head and neck cancer surgery.Laryngoscope. 2012 Oct;122(10):2199-204.
  2. Jones CE, Hollis RH, Gullick AA, Wahl T, Richman JS, Graham LA, Lucy AT, Chu DI, Morris MS.  Venous thromboembolic events: How low can you go? Am J Surg. 2017 Apr;213(4):706-710.
Incidence and Clinical Impact

Learning objectives

  1. Explain the incidence of VTE in otolaryngology-head and neck surgery
  2. Recognize the impact of VTE on patient outcomes

    References

  1. Moubayed SP, Eskander A, Mourad MW, Most SP.  Systematic review and meta-analysis of venous thromboembolism in otolaryngology-head and neck surgery. Head Neck. 2017 Jun;39(6):1249-1258.
Risk Factors

Learning objectives

  1. Understand risk factors for VTE in surgical patients
  2. Stratify DVT  risks for otolaryngology-head and neck surgery patients

References

  1. Clayburgh DR, Stott W, Cordiero T, Park R, Detwiller K, Buniel M, Flint P, Schindler J, Andersen P, Wax MK, Gross N.  Prospective study of venous thromboembolism in patients with head and neck cancer after surgery.  JAMA Otolaryngol Head Neck Surg. 2013 Nov;139(11):1143-50.
  2. Cramer JD, Dilger AE, Schneider A, Smith SS, Samant S, Patel UA.  Risk of Venous Thromboembolism Among Otolaryngology Patients vs General Surgery and Plastic Surgery Patients.  JAMA Otolaryngol Head Neck Surg. 2017 Oct 19.
  3. Shuman AG, Hu HM, Pannucci CJ, Jackson CR, Bradford CR, Bahl V. Stratifying the risk of venous thromboembolism in otolaryngology. Otolaryngol Head Neck Surg. 2012 May;146(5):719-24.
Prophylaxis

Learning objectives

  1.  Understand the rationale and evidence for  various prophylactic strategies for VTE
  2.  Utilize best practices to decide appropriate VTE prophylaxis for individual patients undergoing head and neck and otolaryngologic surgery

 References

  1. Bahl V, Shuman AG, Hu HM, Jackson CR, Pannucci CJ, Alaniz C, Chepeha DB, Bradford CR. Chemoprophylaxis for venous thromboembolism in otolaryngology. JAMA Otolaryngol Head Neck Surg. 2014 Nov;140(11):999-1005.
  2. Ong HS, Gokavarapu S, Al-Qamachi L, Yin MY, Su LX, Ji T, Zhang CP.  Justification of routine venous thromboembolism prophylaxis in head and neck cancer reconstructive surgery. Head Neck. 2017 Dec;39(12):2450-2458.
  3. Garritano FG, Andrews GA.  Current practices in venous thromboembolism prophylaxis in otolaryngology-head and neck surgery. Head Neck. 2016 Apr;38 Suppl 1:E341-5
Review Questions
  1. What measures are in place at your institution to positively or negatively encourage VTE prevention?  Is there any consideration of whether appropriate prophylaxis was in place?
  2. What is the incidence of VTE in general otolaryngology patients as opposed to head and neck cancer patients?
  3. What are the important risk factors that can increase risk of VTE?
  4. Discuss the appropriate prophylactic regimen for a patient undergoing head and neck cancer surgery, including possible microvascular reconstruction.  When is it appropriate to stop chemical prophylaxis?
Resources 

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  1. Annual Meeting Webcasts (AMW):