Thromboembolic Deterrent Stockings Research Articles

236 The Hypercoagulable State in COVID-19 and Implications for Free Flap Surgery in the Lower Limb

Abstract Aim COVID-19 associated coagulopathy is widely documented in severe COVID-19 infection and COVID-19 Vaccine-Induced Thrombotic Thrombocytopaenia. However, much of this evidence relates to macrovascular thrombosis with limited evidence on the impact of previous mild, asymptomatic COVID-19 infection, or vaccination on microvascular thrombosis in free tissue transfer. We compared the rate of thrombotic complications in traumatic lower limb injuries requiring free flap reconstruction in the pre- and post-COVID era. Method Adult patients undergoing lower limb free flap reconstruction were identified at a single centre over two three-month periods (2019 and 2021). Standard thromboprophylaxis was used for all patients (intraoperative intermittent pressure devices, post-operative thromboembolic deterrent stockings, and prophylactic low molecular weight heparin until discharge). Thrombotic complications were recorded and compared using a chi-squared test. Results In the pre-COVID cohort, 51 patients underwent 52 free flaps. One flap (1.9%) suffered anastomotic thrombosis resulting in flap compromise. Post-COVID, 39 patients underwent 43 free flaps. Nine flaps suffered anastomotic thrombosis (21%) and one patient suffered a pulmonary embolus. This increase was statistically significant (p = 0.002). In the post-COVID cohort, four patients had a COVID-19 infection and 25 patients (64%) had at least one dose of a COVID-19 vaccine before free flap surgery. No patients had an active COVID-19 infection on admission. Conclusions In the post-COVID era there was an increased rate of thrombotic complications in lower limb free flap patients. Further research is required to delineate the best course of action when planning free tissue transfer for patients who have had previous COVID-19 infection or vaccination.

316 Improving Electronic Prescribing of Mechanical VTE Prophylaxis in General Surgery Patients

Abstract Aim Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing. Method At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months. Results All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent. Conclusions Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.

TH7.12 Improving electronic prescribing of mechanical VTE prophylaxis in general surgery patients

Abstract Aims Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing. Methods At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months. Results All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent. Conclusions Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.

Venous thromboembolism (VTE) prophylaxis following transurethral resection of the prostate (TURP): An audit of practice in Scotland

Objectives: To establish the current practice of urologists in Scotland with regard to venous thromboembolism (VTE) prophylaxis following transurethral resection of the prostate (TURP). Methods: An electronic survey was distributed to all practicing urology consultants and trainees in Scotland. Participants were asked questions regarding their current practice with regard to peri-operative VTE prophylaxis and were offered free-text responses. Findings were compared with a previous UK-wide study from 2002, and with current European Association of Urology (EAU) guidelines. Results: 56/113 (49.6%) of urologists responded to the survey. Overall, 71.4% of responding urologists prescribed pharmacological VTE prophylaxis following TURP. No urologists routinely prescribe VTE prophylaxis on discharge. 94.6% of responding urologists utilise mechanical prophylaxis in the form of thromboembolic deterrent (TED) stockings, with 35.7% of urologists discharging patients with TED stockings. No urologists reported a death from uncontrollable bleeding after TURP in the previous 10 years, whereas 10% of respondents had a patient whom had suffered a death or serious complication from a thromboembolic event following TURP in the past 10 years. A range of free-text responses were given. Conclusion: Our national audit has identified a wide variation between practice and current published guidance. These results contrast dramatically with a previous UK wide audit from 2002, which found 14% of urologists utilised pharmacological prophylaxis, 50% utilised mechanical prophylaxis only and 23% used no thromboprophylaxis at all. Recent guidance from the EAU recommends against using pharmacological prophylaxis due to the increased bleeding risk. Given that current practice does not marry with published recommendations; we believe that further research is required in this area for stronger evidence-based guidelines to be developed. Level of evidence: 4

AB201. SOH21AS127. Venous thromboembolism prophylaxis in orthopaedic patients: has digital record keeping improved compliance?

Background: Venous thromboembolism (VTE), manifesting as pulmonary embolism (PE) and deep vein thrombosis (DVT), is a common preventable cause of morbidity and mortality among hospital patients however is often overlooked as a major public health problem. Common triggers include surgery, immobilization and hospitalization so orthopaedic patients undergoing joint replacements are particularly susceptible. VTE prophylaxis using prophylactic low molecular weight heparin alongside thromboembolic deterrent stockings (TEDS) are the current international gold standard for all orthopaedic inpatients. This study aims to audit compliance in prescribing VTE prophylaxis on our orthopaedic wards following the introduction of digital medical records in 2019.

The Incidence of Venous Thromboembolism in Patients Undergoing Anterior Lumbar Interbody Fusion: A Proposed Thromboprophylactic Regime

To determine the safety and efficacy of the proposed venous thromboembolism (VTE) prophylaxis regime in patients undergoing anterior lumbar interbody fusion (ALIF) surgery. Deep vein thrombosis (DVT) and pulmonary embolism (PE) are recognized complications after spine surgery, with rates in the literature ranging from 0% to 14% with some form of prophylaxis. Pharmacological thromboprophylaxis can cause postoperative bleeding and hematomas, which can result in significant neural compromise or permanent injury, and wound complications. ALIF surgery involves the handling and compression of major abdominal vessels during surgery and this adds to the risk of both arterial thrombosis and VTE. A retrospective review of data, which were prospectively collected to evaluate the incidence of VTE in 200 consecutive patients undergoing ALIF following our VTE prophylaxis protocol. All patients had low molecular weight heparin, tinzaparin 4500 units subcutaneously on the evening before surgery, then daily for 3 to 5 days, then aspirin (acetylsalicylic acid) 150 mg daily plus lansoprazole 30 mg daily for 4 weeks after surgery. All patients had intermittent pneumatic compression of their calves and thighs intraoperatively and for 24 hours postoperatively then had early mobilization and thromboembolic deterrent stockings for 6 weeks. There was no incidence of any symptomatic VTE in the any of the 200 patients and no loss to follow-up. There was a 0% incidence of injury to the iliac vessels, symptomatic arterial occlusion, wound hematoma, major intraoperative bleeding, need for transfusion, symptomatic GI bleed, or retroperitoneal hematoma requiring intervention. The proposed VTE prophylactic regime is safe and efficacious and may decrease the incidence of symptomatic VTE in patients undergoing an ALIF procedure, and despite the use of chemical thromboprophylaxis, there is no evidence of bleeding complications as a result of using this regime. 4.

The Pathway to Low Outlier Status in Venous Thromboembolism Events: An Analysis of Pancreatic Surgery in the National Surgical Quality Improvement Program.

Purpose: Our institution's hepatopancreaticobiliary surgery service (HPBS) has demonstrated low rates of venous thromboembolism (VTE). We sought to determine whether the HPBS's regimented multimodal VTE prophylaxis pathway, which includes the use of mechanical prophylaxis, pharmacological prophylaxis, and ambulation, plays a role in achieving low VTE rates.Methods: We compared pancreatic surgeries in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant user file with our institution's data from 2011 to 2016 using univariate, multivariate, and matching statistics.Results: Among 36,435 NSQIP operations, 850 (2.3%) underwent surgery by the HPBS. The HPBS achieved lower VTE rates than the national cohort (2.0% vs. 3.5%, p = 0.018). Upon multivariate analysis, having an operation performed by the HPBS independently conferred lower odds of VTE incidence in the matched cohort (odds ratio = 0.530, p = 0.041).Conclusions: We identified an independent correlation between the HPBS and decreased VTE incidence, which we believe to be due to strict adherence to and team participation in a high risk VTE prophylaxis pathway, including inpatient pharmacological prophylaxis, thromboembolic deterrent stockings, sequential compression devices, and mandatory ambulation.

Use of a Muscle Pump Activator Leads to Improved Lower Limb Edema, Lower Limb Blood Flow, and Urine Output Compared With Standard TED Stockings and Compression Devices Following Kidney Transplant: A Randomized Controlled Trial

ObjectiveThe aim of this study was to evaluate the effects of using thromboembolic deterrent (TED) stockings and intermittent pneumatic compression (IPC) vs a muscle pump activator (MPA) device on limb edema and patient satisfaction after transplant. MethodsIn this single-center randomized controlled trial, 118 patients were randomly assigned to wear TED + IPC (n = 64) or the MPA device (n = 54) from postoperative days 1 to 6. We measured patients’ weight and lower leg and thigh circumferences daily. Ultrasonography of the allograft and lower limbs was carried out on postoperative days 1 and 5 to assess resistive index in the transplanted kidney and flow in the femoral vein. We monitored urine output and serum creatinine level. ResultsWe observed a significant increase in calf and thigh circumference from baseline in the TED + IPC group but not in the MPA group (2.3 [SD, 1] cm vs 0.25 [SD, 0.8] cm, respectively, P < .002). Ultrasonography showed higher femoral vein velocities in the MPA group than the TED + IPC group (0.5 [SD, 0.2] cm, P < .001). The mean total urine output in 6 days was higher in the MPA group than the TED + IPC group (P = .05), which corresponded to large change in TED + IPC weight of 6.2 kg vs 2.1 kg in the MPA group (P = .04). Patients were more satisfied with the use of the MPA device than TED + IPC. No major complications were encountered in either group. ConclusionsThis is the first study to show that the use of an MPA device in the immediate postoperative period following kidney transplant leads to decreased lower limb edema and increased total urine output. Patients were more satisfied with the use of the MPA device than TED + IPC.

Thromboprophylaxis in adult and paediatric burn patients: A survey of practice in the United Kingdom

IntroductionPatients with burn injuries are at an increased risk of venous thromboembolism (VTE). This predisposition is secondary to the endothelial injury, hyper-coagulable state and stasis (Virchow’s triad) associated with burn injury. Although the true incidence of VTE in burn patients has not been adequately quantified, symptomatic VTE occurs in 0.2–7% of this population.VTE prophylaxis has proven clinical effectiveness and affords a reduction in the morbidity associated with such events, but the benefits and risk of complications need to be balanced in order to provide the best quality of care.Owing to the lack of prospective data on VTE in burns, practice varies greatly, not only internationally, but also between local burns services. Our aim was to better understand current VTE practice within United Kingdom (UK) burn care services by performing a comprehensive survey. MethodsWe contacted all the inpatient burn care services in the UK and collected data on current VTE practice via a standardised questionnaire. Services were given the choice to complete the survey by telephone or email and a follow-up plan was formulated. ResultsTwenty-five burn care services were contacted and 23 agreed to participate (92% response rate). Responding services treated adults, children or both and lead burn nurses or senior medical staff familiar with current VTE practice were interviewed.Routine VTE prophylaxis was provided in 84% of burn services and the majority utilised a combination of chemoprophylaxis and thromboembolic deterrent stockings (TEDS). All used low molecular weight heparin (LMWH) as their choice of chemoprophylaxis. Of those treating adults, all used a VTE prophylaxis protocol, but none of these applied to children. Only 56% of services treating children had such a protocol. The majority discontinued prophylaxis once patients were mobile. Discussion and conclusionAlthough the true burden of VTE in burn patients is unknown, we recognise that they are a population at risk. In addition to changes in the inflammatory and clotting pathways associated with thermal injury, prolonged hospital stay, ventilatory support, multiple surgeries, numerous central venous cannulations and reduced mobility all multiply this risk.The risk associated with the administration of heparin (bleeding complications and heparin-induced thrombocytopaenia) is low and can be reduced even further to 0.1% by the use of LMWH. The risk of symptomatic VTE is far greater, therefore the benefits of VTE prophylaxis would seem to outweigh the risks of not undertaking prophylactic measures. A higher LMWH dose and routine monitoring of anti-factor Xa levels are useful for acute burn patients.Two previous surveys, performed in Canada and the United States of America (USA), found routine administration of VTE prophylaxis to be 50% and 76% respectively. Of the 71 centres in the USA participating in the survey, 30% used a combination of sequential compression devices (SCD) and heparin and 24% did not provide VTE prophylaxis at all.A lack of prospective data on VTE in burn patients appears to be associated with diverse practice, and consensus on this topic could ensure that the potential morbidity caused by VTE is reduced. A clinical tool for identifying patients at risk and guidelines for management will standardise practice, which in turn should allow us to improve and maintain high quality care for burn patients.

A comparison of different modes of pneumatic compression on muscle tissue oxygenation: An intraparticipant, randomised, controlled volunteer study.

Intermittent pneumatic compression (IPC) to the lower limbs is widely used as a mechanical means to prevent deep vein thrombosis in hospitalised patients. Due to a theoretical concern about impairing blood flow, thromboembolic-deterrent stockings and IPC are considered contraindicated for patients with peripheral vascular diseases by some clinicians. This study assessed whether IPC would alter peripheral limb muscle tissue oxygenation (StO2), and whether such changes were different during 10 minutes of sequential and single-compartment compressions. Twenty volunteers were randomised to have their left or right arm treated with a sequential or single-compartment IPC for 10 minutes, using the contralateral arm without compression as an intraparticipant control. After a five-minute wash-out period, the procedure was repeated on the same arm using the alternative mode of IPC. Both hands' thenar muscles StO2 was monitored every twominutes for 10minutes using the same near-infrared spectroscopy StO2 monitor. Both sequential (3.5%, 95% confidence intervals (CI) 2.7-4.2; p < 0.001) and single-compartment IPC (1.6%, 95% CI 0.4-2.8; p = 0.039) significantly increased muscle StO2 within 10 minutes compared to no compression; and the increments were higher during sequential compressions compared to during single-compartment compressions (2.1%, 95% CI 0.7-3.5; p = 0.023). This mechanistic study showed that both modes of IPC increased upper limb muscle StO2 compared to no compression, but the StO2 increments were higher with the multiple-chamber sequential compressions mode. Contrary to the theoretical concern that IPC may impair peripheral limb tissue oxygenation, our results showed that IPC actually increases oxygenation of the peripheral limb muscles, especially during the sequential compressions mode.

A guideline for the management of specific situations in polycythaemia vera and secondary erythrocytosis: A British Society for Haematology Guideline.

The previous BSH guideline for the management of erythrocytosis was published in 2005 (McMullin et al, 2005) and amended in 2007 (McMullin et al, 2007). Here, we re‐evaluate the literature formulate guidance on the management of specific situations encountered in polycythaemia vera (PV) and the management of the other types of secondary erythrocytosis. Recommendations for the diagnostic pathway of investigation of an erythrocytosis, risk stratification and management of PV are in the accompanying guideline (McMullin et al, 2018). We review evidence and outline guidance on management of acute thrombotic events and secondary prevention of thrombosis in PV. The unusual thrombotic events, splanchnic vein and cerebral vein thromboses are discussed and haemorrhage. The specific situations of surgery and pregnancy and guidance on management of pruritus are included. The evidence for the management of other causes of erythrocytosis, including idiopathic erythrocytosis, congenital erythrocytosis, hypoxic pulmonary disease and post‐transplant erythrocytosis, is reviewed and recommendations made.

Sodium pentosan polysulfate efficacy as thromboprophylaxis agent in high-risk women following gynecological surgery.

Sodium pentosan polysulfate (Na-PPS) is a plant-based agent that has similar action with low-molecular-weight heparin. It inhibits factor Xa, preventing blood clot formation. To date, its use in clinical practice as thromboprophylaxis agent is still limited. In addition, the efficacy and safety profile of this agent was not robustly reported globally, especially for countries with major Muslim population. We hypothesized that Na-PPS was equally effective as the standard thromboprophylaxis. We aim to compare the efficacy and safety of Na-PPS against standard agent (fondaparinux or enoxaparin). This was a randomized control, open-label trial. Women underwent major gynecological surgery were randomized to receive either subcutaneous 50 mg of Na-PPS twice daily or subcutaneous enoxaparin 40 mg once daily. Fondaparinux 2.5 mg once daily was given to Muslim women as an alternative to enoxaparin. The treatment was started 6 h postoperatively, for at least 3 days. All the patients received thromboembolic deterrent stockings. The primary efficacy outcome was venous thromboembolism up to 3 days postsurgery. The main safety outcomes were minor and major bleeding. Among 109 participants, there was no incidence of venous thromboembolism. None of the women developed major bleeding. Minor bleeding was observed in 28.3% (15/53) and 5.4% (3/56) of Na-PPS and standard thromboprophylaxis group, respectively (P = 0.001). Na-PPS was associated with increased risk of minor bleeding. There was insufficient data to conclude its efficacy as thromboprophylaxis. Further research is needed to evaluate Na-PPS safety as a standard thromboprophylactic agent.

Introducing a device to assist in the application of anti-embolism stockings.

Using a device to help with the application and removal of anti-embolism stockings, often called thromboembolic deterrent stockings (TEDS), can potentially facilitate greater adherence to the use of stockings, and potentially reduce the risk of deep-vein thrombosis (DVT). This article describes a quality improvement project which used the Plan, Do, Study, Act (PDSA) cycle to facilitate the introduction of a device to aid in the application of thromboembolic deterrent stockings in an orthopaedic ward. The project findings showed that Neo-slip®, a product designed to facilitate the use of compression stockings, can be effectively introduced into an orthopaedic ward, with positive feedback from both staff and patients.

Lower Limb Compression Prevents Hypotension After Epidural in Labor Patients: A Randomized Controlled Trial [7OP

INTRODUCTION: Approximately 30% of patients who elect to have epidural anesthesia during labor experience hypotension, potentially causing complications for both mother and fetus. We evaluated whether lower limb compression at the time of epidural would decrease maternal hypotension. METHODS: A multisite randomized controlled trial was conducted. Term, singleton parturients requesting epidural were recruited and randomized into one of three arms: control, thrombo-embolic deterrent (TED) stockings, or sequential compression device (SCD). Hospital protocol was followed for intravenous fluid hydration prior to epidural placement. Blood pressures were evaluated at 1, 5, 15, 30, 45, and 60 minutes following administration of epidural bolus. Hypotension was defined as a decrease in either systolic or diastolic blood pressure of greater than 20% from baseline, which was the average of the three blood pressures obtained prior to the epidural. Analysis was based on intention to treat. RESULTS: Data from 71 patients were analyzed: 27 controls, 21 TEDs, and 23 SCDs. Demographics were similar across groups. Hypotension occurred in 66.7% of patients in the control arm compared to 52.4% of patients in the TED arm, and 30.4% in the SCD arm (P=.038). Logistic regression controlling for clinical site, delivery method, maternal age, gestational age at delivery, and maternal BMI did not affect the results. CONCLUSION: Lower limb compression using SCDs significantly decreased the incidence of maternal hypotension in laboring patients receiving epidural anesthesia. Our incidence of maternal hypotension was higher than what is reported in the literature.

Prophylaxis against venous thromboembolism in thoracic surgery patients: Lack of guidelines or inappropriate implementation?

BackgroundVenous thromboembolism (VTE) remains a fatal and preventable event for post-surgical patients. Many guidelines for prophylaxis were proposed for prevention. The aim of this project was to ensure that appropriate methods of VTE prophylaxis were implemented according to the NICE guidelines in a tertiary thoracic surgery unit. MethodsEighty patients who underwent thoracic surgery interventions in a tertiary thoracic surgery unit were included in the study which was carried out on two stages between October 2014 and July 2015. After studying the first forty patients, a risk assessment form was designed to assure proper implementation of the NICE guidelines for VTE prophylaxis and the study was then repeated on further 40 patients. ResultsThere was no difference in both groups regarding age and sex. The risk assessment form resulted in an improvement in VTE prophylaxis by applying thromboembolic deterrent stockings (TEDS) before and after operations (p < 0.001, p = 0.04), administration of Low Molecular Weight Heparin (LMWH) before and after the operation (p = 0.005, p = 0.04) and patient assessment for risk of VTE before surgery (p = 0.006). ConclusionsIn patients undergoing elective thoracic surgery, implementation of the risk assessment form is affordable, and is highly effective in preventing deep vein thrombosis (DVT) and possibly pulmonary embolism (PE) as it is used for follow-up of anti-thrombotic prophylactic protocols’ application. Information about VTE given to patients before surgery and on discharge still needs improvement. Further work should be done on our health systems if this potentially fatal and unsuspected condition is to become totally preventable.

Is compression therapy for thromboprophylaxis still worthwhile today?

SummaryPhysical thromboprophylaxis to prevent deep vein thrombosis of the legs was first introduced in the 1970s and 80s and is still in use. But the question “Is compression therapy for thromboprophylaxis still worthwhile today?” provokes great controversy in the literature. The current German S3 guideline goes so far as to say “Put explicitly, not using thromboembolic deterrent stockings (TEDs) in the vast majority of cases lies completely within the scope of the recommendations in this guideline.” However, the “vast majority of cases” does not mean that it is always right not to use TEDs. The general consensus in the guidelines is the use of compression as a physical means of thromboprophylaxis in patients at high risk of bleeding or with active bleeding, irrespective of whether it consists of TEDs or intermittent pneumatic compression therapy. The decision to use compression in the individual case ultimately rests with the doctor. Physical venous thromboembolism (VTE) prophylaxis still has a place in surgery during the perioperative period when regular pharmacological anticoagulation to prevent VTE has to be interrupted.

Sepsis in emergency surgical patients: Is management optimal?

Sepsis in emergency surgical patients: Is management optimal?

A retrospective study on the classification prevention of early deep venous thrombosis after posterior/transforaminal lumbar interbody fusion

Objective To investigate the safety and efficacy of the classification prevention of early deep venous thrombosis(DVT) after posterior/transforaminal lumbar interbody fusion(PLIF/TLIF). Methods From August 2012 to January 2015, 1 549 patients were separated after PLIF/TLIF procedure with DVT risk factors into low, medium, high and extremely high risk groups for 139, 353, 805 and 252 cases respectively. Basic prevention measures were used in the low risk group. Physical prevention measures such as thigh-length thromboembolic deterrent stockings(TEDS) and pneumatic sequential compression device(PSCD) were used in medium risk group. In high and extremely high risk groups, low molecular weight heparin(LMWH) was applied in addition to basic and physical prevention measures. Lower limb vascular doppler ultrasonography was used to monitor DVT pre-and postoperatively. The occurrences of epidural or wound hematoma were monitored. Results All of 1 057 patients(68.3%) suffered a high risk or extremely high risk of DVT, who have three or more risk factors. Only 139 patients(8.9%) were low risk population. Among the 1 549 cases of patients with PLIF/TLIF procedure, DVT occurred in 27 cases, and the incidence was 1.74%. There were 0, 3, 15 and 9 patients with positive findings of DVT on duplex uitrasonograph respectively in low, medium, high and extremely high risk groups. Two patients were experienced fibular veins thrombosis, and one with posterior tibial vein thrombosis. All of the remaining was thrombus in calf. However, all of them were asymptomatic. There was no case of pulmonary embolism(PE) or case with epidural or wound hematoma. No thrombus progressed was found in 3 months after operation. Among them, one case with fibular veins thrombosis and 11 cases with calf muscular veins thrombosis were recanalized. Conclusion According to the risk factors of DVT after PLIF/TILF, the classification prevention of early DVT is safe and effective. On the basis of basic and physical prevention measures, the combined use of LMWH has important significance to prevent DVT in patients with high and extremely high risk. Key words: Lumbar vertebrae; Spinal fusion; Venous thrombosis; Heparin, low-molecular-weight; Risk factors

The shocking stocking audit: an audit on the use of thromboembolic deterrent stockings (TEDS) for patients having surgery at Sligo regional hospital.

A concurrent audit was conducted over a four week period to determine if patients coming for surgery and wearing thromboembolic deterrent stockings (TEDS) adhered to local policy and recommended guidelines. Data was collected on 30 surgical procedures. The audit highlighted failings in the application of TEDS, identifying poor compliance with correct measurement, application and documentation. It also recognised poor communication between care givers and surgical patients regarding TEDS use. There needs to be an increased awareness about local policy, national and international guidelines regarding the use of TEDS for patients having surgery.

Incidence of Peroneal Nerve Injury Following the use of Anti Thrombo-embolic Deterrent Stockings (TEDS) in Maxillofacial Patients

Incidence of Peroneal Nerve Injury Following the use of Anti Thrombo-embolic Deterrent Stockings (TEDS) in Maxillofacial Patients