[Preoperative evaluation for pulmonary thromboembolism/deep vein thrombosis (venous thromboembolism)]

Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines have been revised, resulting in recommending that most surgical patients should receive thromboprophylaxis with anticoagulants. In addition, the guideline recommend that every general hospital should establish a formal, and active strategy for the prevention of VTE and use automated decision support systems with a computer, suggesting that personal decision should not be made. Regarding preoperative screening for deep vein thrombosis, combination D-dimer concentration and clinical probability score seems most effective. For detection of deep vein thrombosis, sonography for lower limb deep venous thrombosis is required. Anticoagulant thromboprophylaxis absolutely affects choice of anesthetic techniques, especially, neuraxial anesthesia/analgesia or peripheral nerve blocks. Like strategy for the prevention of VTE, anesthetic decision making should be made with automatic decision support systems at every hospital.