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Risk-based evaluation of thromboprophylaxis among surgical inpatients: are low risk patients treated unnecessarily?
G Roche-Nagle1, J Curran, D J Bouchier-Hayes
1Department of Surgery, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin 9, Ireland. grnagle@rcsi.ie
Background:
Venous thromboembolism is a common source of morbidity and mortality but a variety of preventative measures are available.
Aims:
To audit the current practice of thromboprophylaxis and compare against published protocols.
Methods:
Three-hundred and seventy-six (376) surgical patients were surveyed prospectively. A Performa was completed recording the presence of up to 11 risk factors. A risk score was calculated and the use of specific thromboprophylatic measures identified.
Results:
Heparin thromboprophylaxis was widely used, eight patients (who were on aspirin therapy) failed to receive any prophylaxis (risk factors 4-6). In addition there were 60 patients at low risk (risk score <2) received LMWH from which they were unlikely to benefit.
Conclusions:
Thromboembolic prophylaxis is widely but unselectively applied. Adoption of a risk: benefit ratio approach should ensure those who would benefit from thromboprophylaxis are adequately treated while those in whom thromboprophylaxis is not indicated are spared unnecessary therapy.
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