Guidelines for the Prevention of Venous Thromboembolism

This should be performed for all patients.

 

Risk factors

¨ Length of surgery

¨ Age of patient

¨ Recent myocardial Infarction

¨ Congestive cardiac failure

¨ Malignant disease

¨ Infection

¨ Obesity

¨ Pregnancy

¨ Previous thromboembolism

¨ Contraceptive pill

 

            

Risk Category	Criteria for risk	Prevention
LOW	Surgery < 30 mins Any age no other risk factors OR Surgery > 30 mins, age < 40yrs no other risk factors	Early ambulation
Moderate	Surgery > 30 mins, age > 40 yrs OR Surgery any age with risk factors	Subcutaneous Heparin 5000u 2 hrs pre-op then bd or tds until discharge And graded pressure stockings
High	Major orthopaedic surgery of lower limb	Low molecular weight Heparin until discharge and pressure stockings

                                                   

Other forms of thromboembolism are available and may be dictated by local practice

 

Clinical features

 

Thrombosis most often occurs in the pelvis and leg. DVT is often asymptomatic but the leg may be warm and swollen with calf tenderness and superficial venous distension. Classical pyrexia at 7—8 days post-op. May be associated with pain, swelling of leg and rise in skin temperature. Possibly feature of PE.

 

Diagnosis

Doppler ultrasonogeraphy is required for diagnosis of iliofemoral thrombosis. Venography is used to diagnose calf vein thrombosis.

 

Management

All patients with thrombi above the knee must be anticoagulated. Anticoagulation for below knee thrombi is controversial. Anticoagulation is initially with heparin and subsequently with warfarin, usually continued for a period of 3 months.

Risk assessment