Risk-based evaluation of thromboprophylaxis among surgical inpatients: are low risk patients treated unnecessarily?

Abstract

Background: Venous thromboembolism is a common source of morbidity and mortality but a variety of preventative measures are available.

Aims: To audit the current practice of thromboprophylaxis and compare against published protocols.

Methods: Three-hundred and seventy-six (376) surgical patients were surveyed prospectively. A Performa was completed recording the presence of up to 11 risk factors. A risk score was calculated and the use of specific thromboprophylatic measures identified.

Results: Heparin thromboprophylaxis was widely used, eight patients (who were on aspirin therapy) failed to receive any prophylaxis (risk factors 4-6). In addition there were 60 patients at low risk (risk score <2) received LMWH from which they were unlikely to benefit.

Conclusions: Thromboembolic prophylaxis is widely but unselectively applied. Adoption of a risk: benefit ratio approach should ensure those who would benefit from thromboprophylaxis are adequately treated while those in whom thromboprophylaxis is not indicated are spared unnecessary therapy.