Hospital PERT: Bridging VTE care across all disciplines

Abstract

Venous thromboembolism (VTE) comprises deep vein thrombosis (DVT) and pulmonary embolism (PE). Acute PE is associated with significant morbidity and mortality. Hospital admission is a common cause of VTE.

We present a complex case of a young female patient who sustained a right tibial plateau fracture following a traumatic, hyperextension knee injury. The patient was admitted by the orthopaedic team for an open reduction and internal fixation and commenced on prophylactic low molecular weight heparin. Post-operatively, the patient became hypoxic, and computed tomography pulmonary angiogram confirmed bilateral large volume pulmonary emboli with evidence of right heart strain. Following review by the pulmonary embolism response team (PERT), the patient was stratified into an intermediate-high risk group, and received unfractionated heparin, however, remained tachycardic and hypoxic with rising lactate levels. Owing to relative contraindications to systemic thrombolysis, the patient underwent catheter-based thrombectomy and inferior vena cava filter placement. The patient improved dramatically over the course of her admission and was later discharged, asymptomatic from a cardiopulmonary standpoint. In hospitalised patients, early VTE risk assessment and prompt initiation of appropriate thromboprophylaxis are crucial in preventing hospital-acquired VTE (HAVTE). However, in instances of HAVTE in complex patients, a well-coordinated multidisciplinary PERT is necessary to consider alternative strategies for managing intermediate to high-risk PE.