Document Detail

Thromboprophylaxis in surgical patients.
MedLine Citation:
PMID:  12691354     Owner:  NLM     Status:  MEDLINE    
Venous thromboembolism is the most common preventable cause of death in surgical patients. Thromboprophylaxis, using mechanical methods to promote venous outflow from the legs and antithrombotic drugs, provides the most effective means of reducing morbidity and mortality in these patients. Despite the evidence supporting thromboprophylaxis, it remains underused because surgeons perceive that the risk of venous thromboembolism is not high enough to justify the potential hemorrhagic complications of anticoagulant use. The risk of venous thromboembolism is determined by patient characteristics and by the type of surgery that is performed. In this paper we identify the risk factors for venous thromboembolism and provide a scheme for stratifying surgical patients according to their risk. We describe the mechanism of action of the various forms of thromboprophylaxis and outline the evidence supporting thromboprophylaxis in different surgical settings. Finally, we recommend optimal forms of thromboprophylaxis in patients who undergo various types of surgery. Intermittent pneumatic compression, with or without elastic stockings, can be used for thromboprophylaxis in patients who undergo neurosurgical procedures; for patients who undergo vascular or cardiovascular procedures, long-term acetylsalicylic acid should be used for thromboprophylaxis. Low-molecular-weight heparin (LMWH) or warfarin is the choice for patients with spinal cord operations and all patients with major trauma who do not have contraindications to anticoagulation should receive thromboprophylaxis with LMWH.
Martin O'Donnell; Jeffrey I Weitz
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Canadian journal of surgery. Journal canadien de chirurgie     Volume:  46     ISSN:  0008-428X     ISO Abbreviation:  Can J Surg     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-14     Completed Date:  2003-04-25     Revised Date:  2013-06-09    
Medline Journal Info:
Nlm Unique ID:  0372715     Medline TA:  Can J Surg     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  129-35     Citation Subset:  IM    
Henderson Research Centre, McMaster University, Hamilton, Ont.
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MeSH Terms
Anticoagulants / therapeutic use
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee
Heparin, Low-Molecular-Weight / therapeutic use
Risk Assessment
Risk Factors
Spinal Cord Injuries / surgery
Surgical Procedures, Elective
Surgical Procedures, Operative / adverse effects*
Thromboembolism / etiology,  prevention & control*
Venous Thrombosis / etiology,  prevention & control*
Reg. No./Substance:
0/Anticoagulants; 0/Heparin, Low-Molecular-Weight
Comment In:
Can J Surg. 2003 Apr;46(2):90-1   [PMID:  12691343 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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