Introduction to thromboprophylaxis in surgical patients

Abstract

The thromboembolism risk associated with surgery varies according to the procedure being performed, with some surgical procedures carrying little or no risk and others carrying a very high risk. Thromboprophylaxis is effective but is associated with expense, inconvenience and adverse effects. Therefore, it is necessary to make a balanced judgement for each patient. Three key aspects must be considered:

• patient risk;

• procedure risk; and

• prophylactic method — efficacy, safety, cost and convenience. When considering prophylaxis for surgical patients, there are two general approaches. In the first approach, the risk of VTE is estimated by summating the individual’s predisposing factors (Figure 4.1) and the risk of surgical procedures (Figure 4.2) [1]. Data on the risk of clinical thromboembolism (thrombophlebitis, nonfatal PE, fatal PE and chronic venous change) are sparse; the risk is usually assumed from studies using venography as a surrogate (Figure 4.2) [2].