Natasha Mathias1, Barjees Haris2, Abdul Majeed3
Deep Vein Thrombosis (DVT) is a potentially fatal, but preventable complication in patients undergoing major surgery. Studies have shown it to be a common complication following oncosurgeries and orthopaedic surgeries of the lower limbs. Where thromboprophylaxis is indicated, although low molecular weight heparins are currently recommended, they have potential disadvantages such as increase in the cost of treatment and bleeding complications. In contrast to other methods, not much is said about the value of elastic compression bandages in reducing DVT particularly in high-risk patients.
The aim of the study is to evaluate the risk factors and relative frequency of lower limb DVT in patients undergoing general surgery while using mechanical thromboprophylaxis in the local population and thereby determine the need for routine chemical thromboprophylaxis in all high-risk patients.
MATERIALS AND METHODS
The study was conducted at Yenepoya Medical College Hospital between July 2010 and January 2012 where 108 patients expected to undergo major elective general surgeries were initially evaluated by a thorough history and examination for risk factors and signs of pre-existing DVT confirmed by preoperative lower limb venous duplex scans. The indication, nature and duration of the surgery including the type of anaesthesia used were recorded for every patient. Elastic compression bandages were applied to both lower limbs of all patients just prior to surgery and continued postoperatively till the patient was mobilised. Following surgery, the patients were examined daily for clinical signs of DVT and the day of mobilisation postoperatively was also taken into account. A bilateral lower limb duplex venous ultrasound was repeated between the sixth and tenth days postoperatively before discharging the patient.
Out of a total of 108 patients participating in the study, although 4 patients (3.70 per cent) showed clinical signs of lower limb oedema, none of the patients showed radiological evidence of DVT.
DVT following major general surgical procedures can be prevented using mechanical thromboprophylactic methods. In our opinion, although routine pharmacological thromboprophylaxis is perhaps not justified in every patient undergoing major general surgical procedures, a high level of suspicion and close clinical monitoring is mandatory, particularly in patients with risk factors given the high mortality and morbidity associated with the complication.