Surgery is associated with an increased risk of deep venous thrombosis and pulmonary embolism. Identification of patients at risk allows for prophylaxis and early diagnosis.
|
Type of Surgery |
Age of Patient |
Other Risk Factors |
Risk Group |
|
uncomplicated minor |
<= 40 |
none |
very low |
|
major |
<= 40 |
none |
low |
|
major |
<= 40 |
1 risk factor |
moderate |
|
uncomplicated minor |
> 40 |
none |
low |
|
major |
> 40 |
none |
moderate |
|
major |
> 40 |
1 risk factor |
high |
|
major |
> 40 |
previous venous thromboembolus or significant malignant disease or > 1 risk factor |
very high |
Risk factors for venous thrombosis (used as headers in table):
(1) age
(2) major surgery, major orthopedic surgery, or trauma with fracture of pelvis, hip and/or leg
(3) history of previous venous thromboembolus
(4) significant malignant disease
Additional risk factors:
(5) prolonged immobilization
(6) paralysis
(7) obesity
(8) atrial fibrillation
(9) heart failure
(10) myocardial infarction
(11) stroke
(12) hyperhomocysteinemia
(13) oral contraceptives or hormone replacement therapy
(14) inherited hypercoagulable disorders (defects in antithrombin III, protein S, protein C, factor V Leiden, etc.)
(15) acquired hypercoagulable disorders: anticardiolipin antibodies, lupus anticoagulants, polycythemia rubra vera, myeloproliferative disorder, hyperviscosity syndrome
|
Risk Group |
Prophylaxis to Prevent Pulmonary Embolism |
|
very low and low |
early ambulation |
|
moderate |
elastic stockings, low dose unfractionated heparin, or intermittent pneumatic compression |
|
high |
low dose unfractionated heparin, or low molecular weight heparin, or (intermittent pneumatic compression + elastic stockings) |
|
very high |
intermittent pneumatic compression AND (low dose unfractionated heparin or low molecular weight heparin or adjusted dose warfarin) |
Specialty: Hematology Oncology, Clinical Laboratory
ICD-10: ,
