The prevention of post-operative deep vein thrombosis
Author(s)
Howard, Adam Q.
Type
Thesis
Abstract
Background. In a university hospital, disparate and unsatisfactory thromboprophylaxis in surgical patients was found. No hospital consensus was in place for the prevention of postoperative deep vein thrombosis (DVT). Literature review suggested low molecular weight heparin (LMWH) and anti-embolic stockings were the best prophylaxis, however the optimal length ofstocking was unknown. Method. Audit ofthromboprophylaxis in surgical patients and surgical doctors was performed. A randomised controlled tri~l investigated the efficacy and safety ofa new single protocol ofLMWH and the best length ofstocking, for every patient requiring surgery under general anaesthesia. Of426 patients interviewed, 376 were randomised into three stocking groups, Medi Thrombexin???? Climax???? thigh-length, Thrombexin???? Climax~ knee-length amfKendall TEDTM thigh-length. All patients received LMWH. DVT incidence was assessed by duplex ultrasonography. Complications of thromboprophylaxis were recorded. Compliance and health outcome measures were developed to assess patient stocking acceptability. Results. Audit ofthromboprophylft?(is revealed inadequate surgical thromboprophylaxis. A simple 'single protocol' improved doctors' thromboprophylaxis compliance on replicate audit. The randomised trial assessing the 'single protocol' showed no postoperative DVT occurred in the low or moderate-risk patients (n=85). Twenty-one DVT occurred in nineteen patients, all were high-risk patients (n=291): two with Thrombexin???? Climax???? thigh-length stockings and eleven with Thrombexin???? Climax???? kneelength (p<O.05). Six patients wearing TEDTM thigh-length stockings developed DVT. Groups were similar for age, gender, throniboembolic risk, surgical type and protocol compliance. One significant bleeding complication occurred. A validated health outcome measure showed patient satisfaction with knee-length stockings was significantly greater than with thigh-length. However, stocking compliance for in-patients was equal. Whereas patients' compliance with knee-length was significantly greater after hospital discharge. Conclusion. A single protocol employing LMWH and thigh-length stockings abolished DVT (diagnosed by duplex) in low and moderate-risk patients and reduced DVT to 2% in high-risk patients. The 'Blanket LMWHlthigh-length stocking protocol' was effective, safe and the length ofstocking proved significant. A new single protocol and hospital consensus to prevent postoperative DVT was achieved.
Date Issued
2007-01
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Creator
Howard, Adam Q.
Publisher Institution
Imperial College London (University of London)
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)