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DEEP VEIN THROMBOSIS PROPHYLAXIS: A SURVEY OF CURRENT PRACTICE IN AUSTRALIA AND NEW ZEALAND
Author(s) -
Fletcher J. P.,
Koutts J.,
Ockelford P. A.
Publication year - 1992
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1992.tb07529.x
Subject(s) - medicine , pulmonary embolism , deep vein , thrombosis , surgery , venography , compression stockings , heparin , hip surgery , incidence (geometry) , abdominal surgery , low molecular weight heparin , venous thrombosis , arthroplasty , physics , optics
A survey of current practice for deep vein thrombosis (DVT) prophylaxis was undertaken in Australia and New Zealand. The most common indications for prophylaxis were a history of thrombo‐embolism, the type and length of surgery and obesity. Prophylaxis was used in 65% of patients having hip surgery and in 39% undergoing knee surgery. In general surgery the corresponding rate was around 67% for colorectal surgery, hepatobiliary, upper gastrointestinal and major abdominal vascular surgery. Apart from open‐heart cardio‐thoracic surgery (66%), use in other specialties was less than 50%. Physical methods (anti‐embolism stockings, calf stimulation and calf compression devices) were most commonly used for prophylaxis (46%) with heparin being used by 40%. The main side effect reported with heparin was bleeding (18%). The estimated incidence of DVT and pulmonary embolus (PE) was 2.8 and 0.4% for general surgery, 2.7 and 0.7% for orthopaedic surgery and 6.6 and 1.3% for hip surgery. Intravenous heparin followed by oral anticoagulants was the most commonly used treatment for established DVT and nearly all respondents used intravenous heparin and oral anticoagulants for treatment of PE. Venography was the favoured objective test for diagnosing DVT. The principal reason for considering a change in prophylactic policy was the potential availability of an agent with increased efficacy and a reduced incidence of haemorrhagic complications.