Prophylaxis against venous thromboembolism in thoracic surgery patients: Lack of guidelines or inappropriate implementation?

Background: Venous thromboembolism (VTE) remains a fatal and preventable event for post-surgical patients. Many guidelines for prophylaxis were proposed for prevention. The aim of this project was to ensure that appropriate methods of VTE prophylaxis were implemented according to the NICE guidelines in a tertiary thoracic surgery unit.Methods: Eighty patients who underwent thoracic surgery interventions in a tertiary thoracic surgery unit were included in the study which was carried out on two stages between October 2014 and July 2015. After studying the first forty patients, a risk assessment form was designed to assure proper implementation of the NICE guidelines for VTE prophylaxis and the study was then repeated on further 40 patients.Results: There was no difference in both groups regarding age and sex. The risk assessment form resulted in an improvement in VTE prophylaxis by applying thromboembolic deterrent stockings (TEDS) before and after operations (p < 0.001, p = 0.04), administration of Low Molecular Weight Heparin (LMWH) before and after the operation (p = 0.005, p = 0.04) and patient assessment for risk of VTE before surgery (p = 0.006).Conclusions: In patients undergoing elective thoracic surgery, implementation of the risk assessment form is affordable, and is highly effective in preventing deep vein thrombosis (DVT) and possibly pulmonary embolism (PE) as it is used for follow-up of anti-thrombotic prophylactic protocols’ application. Information about VTE given to patients before surgery and on discharge still needs improvement. Further work should be done on our health systems if this potentially fatal and unsuspected condition is to become totally preventable