chemoprophylaxis is used only in appropriate surgical patients and may
minimize bleeding complications.
You should avoid using the popular practice of stopping anticoagula-
tion when the patient is discharged because it's not evidence-based
and could do more harm than good. Your patients might have some
concerns of their own — namely the fear of administering the blood
thinner through injection. If this is the case, you can look into several
approved direct oral anticoagulants (DOACs), which have been
shown to be safe and effective at reducing bleeding. They can be
taken in pill form, rather than an injection, but they tend to be more
expensive.
Periop prevention
Apart from deciding which anticoagulant prophylaxis to use, you
should also take other measures to prevent DVT during and immedi-
ately following surgery on at-risk or high-risk patients.
Muscle relaxants that are used as part of general anesthesia can
increase the size of your patient's leg veins during anesthesia — caus-
ing cracks in the vein lining — and they can slow blood flow out of
the legs, both of which can result in DVT. During surgery on at-risk
patients, use intermittent pneumatic compression (IPC) devices,
which are wrapped around the lower leg or foot and inflate, applying
varying pressure on the leg to help increase blood flow and prevent a
clot during a procedure.
It also helps to keep operations as short as possible. General anes-
thesia that lasts more than 45 minutes can increase the risk of your
patient developing a blood clot by 66% if they have a past history of
DVT.
For patients you've determined to be at risk, take additional post-
operative measures to ensure they don't develop a clot in the weeks
following their surgery. Fit patients for anti-embolism stockings
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