The prevention of postoperative venous thrombosis

Postoperative thrombosis can be effectively prevented by low doses of heparin (5,000 units 2-3 times daily), by dextran (initially 1,500 ml, subsequently 500 ml twice weekly) and by coumarin and indanedione derivatives (prothrombin time 20%). The prophylactic measures substantially reduce the incidence of postoperative thrombosis--which otherwise affects 20-50% of patients subjected to intermediate or major operations--by a factor of 2-10. As every thrombosis is potentially life-threatening, surgeons have a duty to protect all patients from postoperative thrombosis by means of heparin or dextran or, in special circumstances, coumarins. This applies particularly to abdominal and chest surgery, but also to orthopedic surgery and urology. It applies to all gynecological interventions--laparotomies, vaginoplasty, Caesarean section, and every type of sterilization. Finally, the use of drugs to prevent thrombosis has become established, subject to certain conditions, in traumatology, ophthalmology, and even in brain surgery. To reiterate: omission of the prophylactic administration of anticoagulants may constitute a technical error. Without preventive measures, 20-50% of postoperative patients are at risk from potentially life-threatening thrombosis, and 1% are likely to die. Prophylactic measures have reduced this to hardly more than 1/10, i.e., 2-5% of postoperative patients develop thromboses, and one patient per thousand dies of an embolism.