[Prevention of venous thromboembolism in surgery, laparoscopic surgery and urology]

Deep venous thrombosis and pulmonary embolism are major health problems with potential serious outcomes. Acutely, pulmonary embolism may be fatal. In the long term, pulmonary hypertension can develop from recurrent pulmonary embolism. Often overlooked is post-thrombotic chronic venous insufficiency occurring as a result of deep venous thrombosis causing deep venous reflux or obstruction with skin changes and ulceration with adverse impact on quality of life and escalation of health care costs. Almost all hospitalized patients have at least one risk factor for venous thrombosis and approximately 40% have three or more risk factors. Without thromboprophylaxis, the incidence of objectively confirmed, hospital-acquired deep venous thrombosis is approximately 10 to 40% among medical or general surgical patients and 40 to 60% following major orthopedic surgery. Abundant data from metaanalysis and blinded, randomized clinical trials have demonstrated strong evidence that primary thromboprophylaxis reduces deep venous thrombosis and pulmonary embolism and little or no increase in the rates of clinically important bleeding with prophylactic doses of low-dose unfractionated heparin, low-molecular-weight heparin or fondaparinuxem.