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JAMA Patient Page
May 17, 2016

Preventing Venous Thromboembolism After Surgery

JAMA. 2016;315(19):2136. doi:10.1001/jama.2016.1457

Venous thromboembolism (VTE) is the number one cause of potentially preventable death in hospitalized patients.

Venous thromboembolism is a serious and preventable condition in patients who have undergone recent surgery. There are 2 forms of VTE: deep vein thrombosis (DVT) and pulmonary embolism (PE). Deep vein thromboses occur when a blood clot forms in the deep veins, most commonly in the arms or legs. Pulmonary embolisms occur when a DVT breaks off and becomes lodged in the lungs. Venous thromboembolism accounts for 100 000 patient deaths per year.

How Patients Develop VTE After Surgery

First, undergoing surgery itself increases the risk of VTE. Second, many patients spend a lot of time in bed after surgery, leading to poor blood flow. Third, having a previous VTE increases the risk of another VTE. Fourth, other factors including obesity, cancer, VTE in family members, smoking, or chronic health problems increase risk.

VTE Prevention After Surgery

After major surgery, there are 3 important components to reducing the risk of VTE if ordered by a doctor. Patients who have surgery requiring at least an overnight stay should have some type of VTE prevention.

  • Walking: Get out of bed and walk at least 3 times a day. It is important to attempt to get out of bed and walk as much as possible (even just a step or two) to prevent DVTs from forming.

  • Sequential compression devices (SCDs): Wear SCDs whenever in bed or in a chair. An SCD is a sleeve that is wrapped around the leg that, when turned on, squeezes the leg to keep blood moving. These devices are helpful only if they are on the leg, turned on, and working.

  • Blood-thinning medications: Allow nurses to administer the blood-thinning drug ordered by the doctor without skipping any doses. Using a blood-thinning drug is the most effective way to prevent VTE, particularly after major surgery, even if a patient is walking and using SCDs. Skipped doses of blood thinner have been associated with VTE events, so it is very important to take it.

VTE Symptoms

Symptoms of DVT include swelling, tenderness, pain, and/or increased warmth of the skin at the DVT site. Symptoms of a PE include difficulty breathing and chest pain, especially while breathing. Venous thromboembolism can also have no symptoms.

Medications After Hospital Discharge

If a patient has surgery in the pelvis or abdomen for cancer or a total hip or knee replacement, a physician may prescribe a blood thinner to take for a short period after discharge from the hospital.

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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Sources: Centers for Disease Control and Prevention

Haut ER, Lau BD, Kraus PS, et al. Preventability of hospital-acquired venous thromboembolism. JAMA Surg. 2015;150(9):912-915.

Topic: Preventive Medicine