Venous Thromboembolism Prophylaxis In Surgical Patients Research Articles

Pharmacological interventions for preventing venous thromboembolism in people undergoing bariatric surgery.

Pharmacological interventions for preventing venous thromboembolism in people undergoing bariatric surgery.

English

Venous thromboembolism (VTE) is one of the common complications in surgical patients. Venous thromboembolism (VTE), which is manifested as deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a significant cause of death, disability, and discomfort. With the various evidence based studies now we have a better understanding of the VTE/PE risk factors and preventive measures. However most of the hospitals and doctors fall short in implementing the knowledge while treating their patients. Hence the need for the present study to assess the practice pattern of VTE prophylaxis in surgical patients. MATERIALS AND METHODS: It's a retrospective study in which 100 patients were randomly selected from the operation theatre registry. Individual risk assessment was done and VTE prophylaxis given was recorded and then compared with the Caprini's VTE risk assessment model and suggested prophylaxis. RESULTS AND CONCLUSION: Appropriate VTE prophylaxis was given only in 42.03% of the postoperative patients (18.75% of low risk, 29.17% of moderate risk and 65.51% of high risk patients). The remaining 57.97% of patients were at increased risk of developing DVT and pulmonary embolism thus increasing the chances of morbidity and mortality. The prophylaxis was inadequate mainly in the moderate and low risk individuals. Hence there is a strong need for a standard hospital policy for VTE risk assessment and prophylaxis in surgical patients.

Efeito da implementação de diretriz para profilaxia de tromboembolismo venoso em pacientes cirúrgicos

Effective strategies for prevention of venous thromboembolism (VTE) are widely available, but still remain underused, mainly in our country. Our aim was to verify whether the implementation of a guideline for VTE prophylaxis for surgical patients influenced the prescription of prophylaxis by the medical staff. This was a retrospective preintervention-postintervention study. Charts of 150 patients before guideline implementation (BGI) and 150 after (AGI) were randomized among all patients admitted during one year in each period. >40 years-old, major abdominal or orthopedic surgeries. Incomplete files and use of anticoagulants for any reason at admission. Data registered: demographic data, reference to VTE risk factors, VTE prophylaxis prescription, diagnosis of deep venous thrombosis or pulmonary embolism during hospitalization. Results. The two groups, BGI and AGI were similar for demographic data and duration of prophylaxis (5.6 x 6.6 days). Frequency of prophylaxis in percentages was BGI x AGI respectively, before surgery: pharmacologic prophylaxis (PP), 6 x 9; graduated compression stockings (GCS), 4 x 3; intermittent pneumatic compression (IPC), 2 x 3. After surgery: PP, 53 x 53; GCS, 23 x 40 (P<0.05); IPC, 26 x 32. Including all patients, prophylaxis was prescribed for 60.5% BGI and 66.5% AGI, but was considered adequate only in 34% BGI and 32% AGI. Adoption of a guideline, although increasing concern about prophylaxis, expressed by greater use of GCS, only minimally improved quality of prophylaxis , indicating that other active and continuous interventions are necessary to enforce compliance.

Starting Prophylaxis for Venous Thromboembolism Postoperatively

A large proportion of hospitalized patients who are at high risk for venous thromboembolism (VTE) do not receive prophylaxis. Reluctance to use VTE prophylaxis in surgical patients may be due to fear of perioperative bleeding when anticoagulants are given preoperatively. We preformed a literature review to determine (1) whether prophylaxis for VTE is effective when it is started postoperatively and (2) the relative efficacy of preoperatively and postoperatively initiated prophylaxis. Studies were included in the review (1) if they were randomized trials with "blind" assessment of appropriate VTE outcomes, and (2) if prophylaxis was started postoperatively. Randomized, controlled trials establish that pharmacologic and nonpharmacologic methods of prophylaxis that are effective when started preoperatively are also effective when they are started postoperatively, with relative risks for VTE of 0.16 to 0.49. Low rates of VTE in noncontrolled randomized trials that included postoperatively initiated prophylactic regimens support this finding. The relative efficacy of preoperatively and postoperatively initiated VTE prophylaxis could not be determined definitively, as direct comparisons of the same regimens have not been performed. Indirect comparisons suggest that any loss of efficacy resulting from deferring VTE prophylaxis until after surgery is unlikely to be marked. Randomized trials are required to resolve this question. This comparison may be of greatest clinical importance when twice-daily, low-molecular-weight heparin is used to prevent VTE after major orthopedic surgery.