Prevention of postoperative venous thromboembolism

Abstract

The publication of the 1991–1992 report of the National Confidential Enquiry into Perioperative Deaths (NCEPOD) [10] drew attention to prophylaxis against venous thromboembolism in surgical patients as an area of clinical practice that requires attention. The report found that pulmonary embolism is an important cause of mortality in postoperative surgical patients and was responsible for 7 % of all deaths. The role of prophylaxis against venous thromboembolism was not investigated in great detail but the findings suggested that it is not being given to all patients in whom it could be considered appropriate. In high-risk hip replacement patients, for example, 33 % did not receive any prophylaxis against venous thromboembolism. The recommendations made in the NCEPOD report were that every hospital should have an agreed policy for prophylaxis against venous thromboembolism, all surgeons should be made aware of the problem and implementation of the policy should be audited regularly. The aim of this review of the prevention of venous thromboembolism is to identify patients who benefit, discuss the merits of different methods, investigate areas of controversy and explore the role of anaesthetists.