Wheeler H B, Anderson F A
Department of Surgery, University of Massachusetts Medical Center, Worcester 01655.
Am J Surg. 1991 Apr;161(4):507-11. doi: 10.1016/0002-9610(91)91122-y.
Venous thromboembolic disease is a common, potentially life-threatening, but preventable complication of surgery. Venographic studies have shown a high incidence of deep vein thrombosis in patients who do not receive prophylaxis. The long-term sequelae of deep vein thrombosis in these patients can be disabling, but the exact prevalence of post-thrombotic complications has not been well documented. Fatal pulmonary embolism has been reported in 0.5% to 1% of patients after major abdominal surgery and in 2% to 6% after total hip replacement. Several methods of prophylaxis against venous thromboembolism have demonstrated efficacy, but a surprising number of patients still do not receive prophylaxis. A medical record review in 16 hospitals recently disclosed that only 32% of high-risk patients received prophylaxis, with a range from 9% in a community hospital to 56% in a major teaching hospital. The possible reasons for this comparatively low rate of utilization are discussed. Current issues and future trends in the prophylaxis of venous thromboembolism are briefly summarized.
