DVT incidence low after general surgery with thromboprophylaxis
MedWire News: The incidence of deep vein thrombosis (DVT) after general surgical operations is low when appropriate prophylaxis is used, US research shows.
When cases do occur, they are mostly diagnosed in the inpatient setting and are associated with central catheter use, report Ninh Nguyen (University of California, Orange) and colleagues in the Archives of Surgery.
The researchers explain that up to 40% of general surgery patients will develop DVT in the absence of prophylaxis, and 1% will die. In spite of this, surgeons have resisted adoption of aggressive chemoprophylaxis methods because of bleeding concerns.
Recent data suggest that thromboprophylaxis is associated with significant reductions in DVT and a low rate of major bleeding, but few data exist regarding the specifics of DVT formation when general surgical patients receive adequate prophylaxis.
To characterize the location, incidence, and timing of postsurgical DVT, Nguyen and team retrospectively reviewed the medical records of 2189 patients who underwent general operations (including surgeries of the pancreas, esophagus, stomach, intestines, colon, and rectum, as well as other body parts) during 2008 and 2009.
The researchers report that compliance with DVT prophylaxis in accordance with Surgical Care Improvement Program criteria was high, and averaged 93% over the study period. Even so, 35 (1.6%) patients developed DVT.
Most cases (94.3%) of DVT were symptomatic, and the rest were detected during routine screening. DVT was diagnosed a mean of 8.6 days after the operation, and in 83.0% of cases in the inpatient setting.
Similar numbers of patients developed upper-extremity DVT (40.0%) or lower-extremity DVT (45.7%), and 14.3% developed the condition in both areas.
The researchers note that the majority of cases (60%) were associated with the presence of an in-dwelling central or peripherally inserted central catheter.
Other underlying health problems, such as ventilator dependency, sepsis, renal failure, surgical site infection, and pneumonia were present in 62.9% of patients, while 11.4% also developed pulmonary embolism.
"With more than half of DVTs being caused by central catheters, efforts toward DVT prevention should include closer scrutiny to the need for central catheters, including limiting the duration of central catheters, and consideration of the added use or perhaps higher dose of anticoagulation when central catheters are present," Nguyen and co-authors conclude.
By Laura Dean