Applying risk assessment models in general surgery: overview of our clinical experience

Venous thromboembolism (VTE) is an important complication of general surgery. Epidemiological data demonstrate that the incidence of VTE may exceed 50% in some patient groups in the absence of prophylaxis, but the risk varies widely in different types of general surgery. A large number of concomitant risk factors for VTE have now been identified, including intrinsic patient factors such as older age and a previous history of VTE. Over recent years, several consensus conferences have defined categories for different levels of thromboembolic risk in general surgery based on clinical criteria, and have made prophylaxis recommendations according to the degree of risk. Existing physical and pharmacological methods of prophylaxis, particularly low-molecular-weight heparins, have been shown to be safe and effective in reducing thromboembolic risk to very low levels in the majority of patients undergoing general surgical procedures. However, these measures are currently underused, due both to underestimation of thromboembolic risk and fear of haemorrhage. Furthermore, some patient groups, such as those undergoing neurosurgery or with malignancy, remain at significant risk of VTE despite conventional prophylaxis. More accurate stratification of patients for thromboembolic risk, using evidence-based prophylaxis recommendations may lead to improved thrombosis prevention. Validation of independent thromboembolic risk factors and risk assessment models will assist in patient stratification, and allow identification of very-high-risk patients. Novel anticoagulant therapies currently under development may offer a superior antithrombotic:haemorrhagic ratio, providing improved protection in very-high-risk patients.