Introducing a procedure-specific Venous Thrombo-Embolism (VTE) chemoprophylaxis protocol for thyroid surgery patients

Abstract

The updated 2014 British Thyroid Association thyroid cancer guidelines recommends that chemoprophylaxis is not routinely indicated as there is no increased risk of Veno-Thrombo Embolism (VTE) in patients undergoing thyroid surgery. Contrasting this, our recently instituted Trust wide VTE prophylaxis guidance meant that all patients with a potential thyroid cancer diagnosis would require chemoprophylaxis.The literature was reviewed and chemoprophylaxis was found to increase the bleeding risk post thyroid surgery. A project was undertaken to balance the risk of VTE with the potential for increased morbidity following thyroid surgery and produce procedure specific guidelines.Retrospective analysis found that in contrast to national standards, 78% of patients had chemoprophylaxis and there was a 9% post-operative haematoma rate. Departmental audit, literature review and discussion with Trust audit lead allowed for development and implementation of a variant VTE prophylaxis guidance allowing a scoring system for intermediate group (medium risk) in addition to previous low and high risk groups.The change in practice was followed by further analysis showing a reduction in post-operative haematoma to 0% with no increased incidence of VTE, highlighting that adoption of a procedure specific VTE policy has allowed for safe practice but continuous monitoring is essential to maintain improvement.