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Prevention of Venous Thrombosis

Prevention of Venous Thrombosis | ASCRS


The risk of deep vein thrombosis (DVT) is present in all forms of major surgery. Patients undergoing surgery of the colon and rectum are at particularly high risk for DVT and its potentially life-threatening complication of pulmonary embolism (PE). In examining the results of several randomized trials of DVT prophylaxis, the risk of a colorectal surgical patient developing DVT is at least 30 percent compared with approximately 20 percent for general surgery patients. It is easy to overlook the importance of DVT because most episodes are asymptomatic and the incidence of the most dramatic and memorable manifestation—pulmonary embolization—is comparatively infrequent. Furthermore, the potentially devastating complications associated with postphlebitic syndrome typically take years to manifest. In general surgical patients who do not receive prophylaxis, the rate of PE is approximately 2 percent, and it is nearly 3 percent in colorectal surgical patients. Nevertheless, PE remains the most common cause of preventable death in hospitalized patients and usually occurs without warning. Prophylaxis also reduces the potential morbidity of long-term anticoagulation, chronic venous insufficiency, and pulmonary embolism.