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[Comprehensive prevention of postoperative thrombosis]
1I. chirurgická klinika a Ustav patologickej fyziológie Lekárskej fakulty Univerzity Komenského v Bratislave, Slovakia.
Bratislavske Lekarske Listy
|February 1, 1996
Summary
Postoperative deep vein thrombosis (DVT) is a serious complication. A complex prevention strategy involving heparin, dextran, and antiplatelet agents significantly reduced DVT occurrence in high-risk patients from 24% to 5.6%.
Area of Science:
- Vascular Surgery
- Thrombosis Research
- Preventive Medicine
Background:
- Postoperative thromboembolic disease presents a significant risk, with incidence rates of 25-50% in high-risk surgical patients.
- Traditional diagnostic methods for deep vein thrombosis (DVT) have shown low sensitivity and specificity.
- Thrombosis is a multifactorial process requiring comprehensive preventive measures targeting hemostatic disturbances.
Purpose of the Study:
- To evaluate the efficacy of a complex, multifactorial preventive strategy for postoperative deep vein thrombosis (DVT) in high-risk surgical patients.
- To compare the incidence of DVT in patients receiving the complex prevention versus those receiving no prevention.
- To assess the impact of the prevention protocol on coagulation parameters and fibrinolysis.
Main Methods:
- A cohort of 160 high-risk patients received no prevention, with DVT detected via fibrinogen accumulation test and phlebography.
- A subsequent group of 176 high-risk patients received a complex prevention protocol: low-dose heparin, pre-operative hemodilution with Dextran, and pre-operative antiplatelet agents (Acylpyrin).
- Hemocoagulation examinations monitored 10 basic factors pre- and post-operatively in both groups.
Main Results:
- The incidence of DVT in the unprevented group was 32.4% (fibrinogen test) and 24% (phlebography).
- In the group receiving complex prevention, DVT incidence significantly decreased to 5.6% (p > 0.0005).
- Clinically significant bleeding occurred in only 1% of patients in the prevention group, with detected thrombi localized to short segments of crural veins.
Conclusions:
- Complex, multifactorial prevention is highly effective and safe for reducing postoperative DVT in high-risk patients.
- The implemented strategy normalizes hypercoagulability and depressed fibrinolysis associated with thrombosis.
- Clinical diagnosis of DVT is unreliable; objective diagnostic methods and effective prevention are crucial for managing this complication.