Deep vein thrombosis in Sri Lankans - time to take notice

In 1984 Sheriffdeen (1) reported 16 cases of deep vein thrombosis (DVT) complicating vaginal hysterectomy, abdominal hysterectomy, myomectomy, caesarian section and sapheno-femoral ligation. He emphasised that the prevalence of DVT in the Sri Lankan population was appreciable, but probably an under-estimate, and sugges ted that raising awareness, and the use of Doppler ultrasound flow detector and venography, would increase the degree of diagnostic accuracy of DVT (1). Seventeen years later, the Doppler ultrasound flow detector is still not freely available in the state health service and no meaningful efforts have been made to prevent DVT or minimise the morbidity and mortality associated with it. This attitude may well have its roots in the false belief that DVT is rare among Sri Lankans and all Asians. The use of l 2 I labelled fibrinogen alerted the western world to the reality that incidence of DVT in post-surgical patients in the UK was as high as 44% (2). Using the same technique, Shead and Narayanan in South India reported an incidence of 28% (3). Reports from Malaysia (4), Sudan (5), Hong Kong (6) and Thailand (7) give the respective incidence as 11.7%, 12.0%, 2.6% and 3.0%. A literature survey shows that different researchers report varying results, even within the same country, on the incidence of DVT. It was stated in a standard textbook of surgery in 1984 (8), that "postoperative thrombosis is virtually unknown in tropical countries like Singapore". But in 1993, a group from this country reported an incidence of 11.4% after rectal surgery. Of these, three patients developed pulmonary embolism and one died (9). A Sri Lankan study in 1986 did not detect a single case of post-operative DVT using I U I fibrinogen in patients after prostatectomy (10). The University Surgical Unit of the Faculty of Medicine, Colombo, detected post-operative DVT in 63 of 137 consecutive patients (45.9%) referred to the unit with a swollen leg over a 10-month period. Of these patients 33% had a recent history of surgery or trauma (11). DVT also occurs world-wide in patients hospitalised for medical illnesses and pregnancy (12).