Author: Zhejiang Pulmonary Embolism and Deep Vein Thrombosis Prevention and Treatment Alliance

Background and Objectives

The Expert Consensus on the Prevention and Treatment Management Guidelines for Pulmonary Embolism and Deep Vein Thrombosis in Zhejiang Provincial Hospitals is based on the construction of prevention and treatment management systems in medical institutions at all levels and baseline data. It provides in-depth descriptions in several areas, including management system architecture, prevention and treatment scales and project requirements, patient education and management, multidisciplinary treatment (MDT) models, green channels, and information technology development. The purpose is to provide suggestions for better standardizing VTE prevention and treatment management in Zhejiang provincial hospitals.

Building Standardized VTE Prevention and Treatment Management Guidelines

1. Establishing a Hospital VTE Prevention and Treatment Management System

1.1 Hospital Level: Hospital leadership, relevant functional departments, and all medical staff should pay attention and participate in VTE prevention and treatment.

• Establish a Hospital VTE Prevention and Treatment Management Committee

• Chairperson: The hospital president or vice president responsible for medical affairs.

• Responsibilities: Oversee the entire hospital's VTE prevention and treatment efforts.

• Members: Heads of functional departments and clinical/medical departments.

• Responsibilities: Formulate VTE prevention and treatment policies for the hospital, define high-risk VTE departments such as orthopedics, general surgery, oncology, gynecology, obstetrics, urology, neurology, neurosurgery, burns, intensive care units, etc., and adjust dynamically based on actual conditions.

• Nursing Department and Nurse Managers of Relevant Departments

• Responsibilities: Develop VTE-related nursing processes and guidelines, implement VTE prevention work, and carry out standardized patient education.

• Establish a VTE Prevention and Treatment Management Office

• Responsibilities: Under the direct leadership of the management committee, it is responsible for specific execution and daily operations.

• Members: Personnel from medical, nursing, quality management, information technology, clinical, and medical technology departments.

• Responsibilities: Conduct VTE prevention and treatment training, quality control, supervision, and continuous improvement in the hospital.

1.2 Department Level:

• Responsibilities: Clinical departments should carry out VTE prevention and treatment work based on their specific situations and the latest specialized VTE prevention and treatment guidelines or expert consensus.

• Establish a VTE Prevention and Treatment Management Team and Emergency Team

• Team Leader: Department head.

• Team Members: Doctors and nurses from the department.

• Responsibilities: Refer to the hospital’s VTE prevention and treatment management methods and work manuals to develop relevant management systems and emergency plans suitable for the department, clarify responsibilities, hold regular meetings, and analyze and improve the department's VTE prevention and treatment efforts.

2. Establishing a Comprehensive Inpatient Risk Assessment System

2.1 Inpatient VTE Risk Assessment: Inpatients should undergo VTE risk assessments according to hospital requirements, with standardized processes and regulations for VTE risk assessment for inpatients.

• VTE Risk Assessment Scales:

• Surgical/Procedural Patients: Caprini Risk Assessment Scale (2021 version), as shown in Table 1.

• Non-Surgical/Procedural Patients: Padua Risk Assessment Scale, as shown in Table 2.

• DVT Clinical Symptoms: DVT Wells Score and Grading Scale for clinical assessment (Table 3). For suspected acute PE patients, clinical likelihood can be assessed using Simplified Wells Score and Geneva Score for Pulmonary Embolism, as shown in Table 4.

• Cancer Patients: Caprini Risk Assessment Scale and Khorana Risk Assessment Scale, as shown in Table 5.

• Pregnant and Postpartum Patients: Risk factors for VTE in pregnancy and the postpartum period and corresponding preventive measures, as shown in Table 6.

• Three Key Dynamic Assessment Timepoints for Inpatient Assessment:

• Within 24 hours after admission.

• When there are changes in the patient's condition or treatment (e.g., surgery or procedures within 24 hours before or after, transfer to another department within 24 hours, or reporting critical illness).

• Within 24 hours before discharge.

2.2 Inpatient Bleeding Risk Assessment: For inpatients with VTE risk, bleeding risk should be assessed (see Table 7 and Table 8), with standardized processes and regulations for bleeding risk assessment.

2.3 Assessment Rate Evaluation for Inpatients:

• VTE Risk Assessment Rate: The ratio of the number of discharged patients who received VTE risk assessments to the total number of discharged patients during the same period (excluding patients who could not be assessed).

• Bleeding Risk Assessment Rate: The ratio of the number of patients who received bleeding risk assessments to the number of patients with a medium or high VTE risk during the same period. The assessment rate should be greater than 90%.

3. VTE Prevention and Treatment Testing and Examination Requirements

3.1 Examination Items:

• 24-hour electrocardiogram and echocardiography (including emergency bedside 24-hour monitoring).

• Lower limb venous ultrasound (including emergency bedside 24-hour monitoring).

• Pulmonary Artery CT Angiography (CTPA) with a 24-hour green channel setup.

• Pulmonary ventilation/perfusion (V/Q) imaging.

• Lower limb venography.

• Laboratory Testing Items:

Plasma D-dimer, coagulation function tests (results within 2-4 hours), thromboelastography, cardiac biomarkers (at least troponin, BNP, etc.), among others.

To be continued, please stay tuned.

[1] Liang Tingbo. Expert Consensus on the Prevention and Treatment Management Guidelines for Venous Thromboembolism (VTE) in Zhejiang Provincial Hospitals (Second Edition) [J]. Journal of Accelerated Recovery Surgery, 2023, 6(3): 97-109.