Surgical Preventive Measures Result in Fewer DVT’s

A new study indicates that the odds of postoperative deep vein thrombosis (DVT) steadily declined after the implementation of a multicomponent prevention program.

Researchers at Boston University School of Medicine (MA, USA) and Boston Medical Center (BMC; MA, USA) developed a strategy to decrease venous thromboembolism (VTE) complications, based on standardized electronic physician orders that specify early postoperative mobilization and mandatory VTE risk stratification for every patient, using the Caprini grading system. The derived scores dictate the nature and duration of VTE prophylaxis, including on an outpatient basis.

The VTE prevention program placed an emphasis on early postoperative mobilization (walking three times a day, starting on the day of the operation). Additional components included standardized risk assessment using five categories of VTE risk; risk-based prophylaxis involving inflatable pressure boots and/or low doses of anticoagulants; electronic physician orders that specified appropriate preventive treatment; and patient education. The researchers also monitored physicians’ adherence to the automated recommendations.

The results of the study showed that the incidence of DVT decreased by 84% (from 1.9% to 0.3%) with the implementation of VTE prevention efforts, while pulmonary emboli incidence fell by 55% (from 1.1% to 0.5%). The risk-adjusted VTE outcomes steadily declined from an odds ratio of 3.41 to 0.94. The surgeons' compliance rates ranged from 100% for patients at low or moderate risk for a VTE to 77% for patients in the highest risk category. The study was published in the June 2014 issue of the Journal of the American College of Surgeons.

“A patient care program, emphasizing early postoperative mobilization along with mandatory VTE risk stratification and commensurate electronic prophylaxis recommendations, significantly reduced the likelihood of VTE complications among our patients,” concluded coauthor David McAneny, MD, FACS, vice chair of surgery at BMC. “We are encouraged by the success in reducing the frequency of these devastating events among our patients by implementing this prevention program.”

VTE is a significant cause of mortality, long-term disability and chronic ill-health problems, and are caused mainly by a combination of venous stasis and hypercoagulability, but to a lesser extent also by endothelial damage and activation. One in 20 people will have a VTE at some time in their life and the risk increase with age. It is estimated that as many as half of all cases of VTE are associated with hospitalization for medical illness or surgery.

Related Links:
Boston University School of Medicine
Boston Medical Center