[The advantages and disadvantages of surgical prevention of thrombosis]

Abstract

The need for providing for a prophylaxis against thrombosis in surgery is now generally acknowledged in view of a basic risk of 10-60% thromboses and 1-5% fatal pulmonary embolisms. Initial efforts to recognise risk of thrombosis in patients on the basis of certain characteristic signs have not been successful, so that general prophylaxis is now fundamentally preferred. Measures of physical prophylaxis of thrombosis have been only partly successful, but the effort required to apply them in practice is out of all proportion to the effect achieved, so that this type of prophylaxis can only be used as a complement to drug therapy and with special high-risk patients. Although anticoagulation is effective, its rate of side effects is so high and the technical difficulties involved are so great that this method cannot be recommended in general prophylaxis of venous thrombosis. This also applies, albeit less dramatically, to thrombose prophylaxis with dextranes; in fact, these must be used with caution only, especially in elderly patients. Completely useless but characterised by considerable side effects is the attempt to achieve venous thrombosis prophylaxis via aggregation inhibitors. Today the standard method in surgery is low-dose heparin prophylaxis according to the effectivity-risk calculation. By applying the conventional non-fractionated heparins according to the low-dose schema it was possible to lower the pulmonary embolism mortality in all surgical disciplines with the exception of traumatology and orthopaedics to one third and the thrombosis rate to one third and the thrombosis rate to one third to one fourth of the original risk.(ABSTRACT TRUNCATED AT 250 WORDS)