O C T O B E R 2 0 1 7 O U T P A T I E N TS U R G E R Y. N E T 6 9
• Scores ≤ 5. Patients require basic prophylaxis with pneumatic compression
stockings or sequential compression devices.
• Scores of 5 to 8. Patients are at heightened risk of clotting and require a
week of post-operative anticoagulant prophylaxis.
• Scores ≥ 8. Patients are at significant risk of post-op clotting and should
receive a month of anticoagulant therapy.
Patients with a history or family history of thrombosis and abdominal surgery
for cancer should receive 30 days of prophylaxis, even with scores < 8.
Don't be lulled into believing that minor surgery doesn't hold major blood-clotting
risks. Although the surgery may be minor, any procedure requiring general or region-
al anesthesia lasting longer than 1 hour poses a thrombotic risk. Outpatients are just
as likely as inpatients to suffer clots, because of the anesthesia time.
With proper pre-op risk assessment and appropriate prophylaxis, the risk of
DVT can drop to as low as 0.3%. Without both, the risk soars to 5% to 10%.
What's the most effective anticoagulant prophylaxis therapy? That's a decision
you'll make on a case-by-case basis. What matters more is that the therapy is
used for as long as patients are deemed to be at risk of developing clots.
It's challenging to get patients who undergo relatively minor procedures to
inject themselves with the blood thinner heparin every day for 2 to 4 weeks fol-
lowing surgery. Novel oral anticoagulants have been approved for DVT prophy-
laxis after orthopedic procedures and will likely be approved for the same use
following other surgeries. Patients are more likely to take anticoagulant pills
than they are to self-inject, and that has the potential to save countless lives.
Anesthetized patients typically receive a muscle relaxant to suppress the gag
reflex during intubation. The drug also paralyzes leg muscles. When muscle tone
is lost in the legs, the veins expand and, after about an hour, can cause the inner
linings of veins to crack. Blood clots can occur as a result of these changes.
Applying sequential compression devices during all surgeries is an excellent
way to prevent the sludging of blood, damage to veins and accelerated blood
