الفهرس 
Pathophysiology of Venous ThromboembolismOnly 14 pages are availabe for public view
 |  | from | 163 |  |  |
| | | from | 163 | | |
Abstract
Venous thrombo-embolism (VTE) is a common and potentially lethal complication of hospitalization. Critically ill patients specially pregnant have multiple risk factors for VTE such as prolonged immobility, use of central venous catheters, and the diseases that lead to intensive care unit (ICU) admission.
Venous thrombo-embolism results from a combination of hereditary and acquired risk factors, also known as thrombophilia or hypercoagulable states. In addition, vessel wall damage, venous stasis, and increased activation of clotting factors first described by Rule of Virchow more than a century ago still remain the fundamental basis for the understanding of thrombosis. Most clinical studies of VTE in the critically ill focus on DVT. It is estimated that 90% of cases of Pulmonary Embolism (PE) originate in the deep venous system of the lower limbs.
Critically ill patients especially pregnant are at increased risk of VTE due to their premorbid conditions, admitting diagnosis such as sepsis and trauma, and events and exposures in the ICU such as central venous catheterization, invasive tests and procedures, and drugs that potentiate immobility.
The management of venous thrombo-embolism in pregnancy is challenging, as many diagnostic tests are less accurate in pregnant than in non-pregnant patients and some of the radiological procedures are potentially hazardous to the fetus. In addition, anticoagulant treatment with coumarins can cause embryopathy. The authors recommend strategies for women at risk of deep venous thrombosis or pulmonary thrombo-embolism during pregnancy and outline appropriate investigations and treatment.
Before anticoagulant treatment is commenced, blood should be taken for a full thrombophilia screen, a full blood count and a coagulation screen. Blood should also be sent for urea, electrolytes and liver function tests, to exclude renal or hepatic dysfunction, which are cautions for anticoagulant therapy. Although the results of a thrombophilia screen will not influence immediate management, they can provide information that can influence the duration and intensity of anticoagulation, such as when antithrombin deficiency is identified. Thus, it is important to be aware of the effects of pregnancy and thrombus on the results of a thrombophilia screen. For example, protein S levels fall in normal pregnancy, making it extremely difficult to make a diagnosis of protein S deficiency during pregnancy.
This work aims to discuss different methods for diagnosis and treatment of venous thrombo-embolism (VTE). In addition, this work presents how to prevent dangerous sequelae such as pulmonary embolism, post thrombotic syndrome and recurrent (VTE).