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Prevention of venous thromboembolic disease in surgical patients

Authors
Menaka Pai, MD, FRCPC
James D Douketis, MD, FRCPC, FACP, FCCP
Section Editors
Lawrence LK Leung, MD
Jess Mandel, MD
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Using the 2003 nationwide inpatient sample from the Health Care Cost and Utilization Project in the United States, there were over 38 million discharges in 2003 [1]. Twenty percent of those were surgical inpatients and, using the ACCP Guidelines for risk stratification, it was estimated that 15 percent, 24 percent, and 17 percent were at moderate, high, or very high risk for venous thromboembolism (VTE, which includes deep vein thrombosis and pulmonary embolism).

Despite significant advances in the prevention and treatment of VTE, pulmonary embolism remains the most common preventable cause of hospital death [2-6], responsible for approximately 150,000 to 200,000 deaths per year in the United States [7,8]. Thus, it is vital that efforts continue to be made to find the safest and most effective means of preventing and managing VTE.

Practical approaches to the prevention of VTE in surgical patients will be reviewed here. Prevention of VTE in medical patients is presented separately. (See "Prevention of venous thromboembolic disease in acutely ill hospitalized medical adults".)

Detailed discussions about specific pharmacologic agents employed for VTE prevention are presented separately. (See "Heparin and LMW heparin: Dosing and adverse effects" and "Warfarin and other VKAs: Dosing and adverse effects" and "Fondaparinux: Dosing and adverse effects" and "Low molecular weight heparin for venous thromboembolic disease".)

PROBLEM OVERVIEW

In the United States there have been a number of initiatives aimed at calling attention to the prevalence of VTE and increasing the use of prophylaxis of VTE in the hospital setting. These initiatives have come from the National Quality Forum [9], the Surgical Care Improvement Project [10], the Centers for Medicine and Medicinal Services, the Joint Commission on Accreditation of Health Care Organizations [11], and the Office of the Surgeon General of the United States [12]. Similar initiatives have been developed in Canada [13], the United Kingdom [14,15], and Europe.

                                               

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Literature review current through: Nov 2016. | This topic last updated: Fri Oct 07 00:00:00 GMT+00:00 2016.
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