Duration of deep vein thrombosis prophylaxis in the surgical patient and its relation to quality issues

Abstract

Background: Venous thromboembolism (VTE) is a major cause of mortality and morbidity in patients after major surgery. The US Acting Surgeon General issued a "call to action" to reduce the number of VTE cases nationwide.

Data sources: PubMed literature searches were performed to identify original studies.

Results and conclusions: Noncompliance with VTE guidelines is common in clinical practice. Thromboprophylaxis is frequently stopped on discharge, not meeting recommendations for standard-duration prophylaxis (7-10 days) because of shorter hospital stays or for extended-duration prophylaxis (10-35 days). Appropriate pharmacologic prophylaxis options for orthopedic surgery patients include the low-molecular-weight heparins (LMWHs), fondaparinux, or warfarin (10-35 days). For patients undergoing abdominal surgery for cancer, the LMWHs are recommended beyond hospitalization (up to 28 days). Performance measures should help establish VTE-prevention policies that close the gap between guideline recommendations and clinical practice in a greater number of hospitals.