How to Prevent Thromboembolic Events in Surgery
Thromboembolic events, such as deep vein thrombosis (DVT) and pulmonary embolism (PE), are among the most serious complications in surgical practice. Prevention is essential to ensure patient safety and improve outcomes. Fortunately, with careful planning and adherence to established protocols, these events have become increasingly rare in modern surgical practice.
Assessing Risk: The Caprini Scale
One of the most widely used tools for assessing the risk of thromboembolic events is the Caprini Scale. This scale takes into account multiple patient factors, including:
- Age
- Body mass index (BMI)
- Preexisting illnesses
- Use of hormonal medications such as contraceptives
- History of prior thromboembolic events
Based on these factors, patients are classified into low, medium, or high risk. This classification is crucial because it guides the preventive measures that will be implemented before, during, and after surgery.
Preoperative Measures
Prevention begins well before the surgery itself. One key strategy is to temporarily stop medications that affect blood coagulation, including contraceptives and other hormonal therapies, approximately two to three weeks before surgery.
Another important consideration is surgical planning. Procedures are carefully timed to avoid excessively long operations. Surgical times exceeding five to six hours increase the risk of thromboembolic events and should be avoided whenever possible.
In aesthetic procedures, such as liposuction, additional precautions are necessary. Liposuction in overweight patients, especially when removing large amounts of fat, carries a higher risk due to potential blood loss and subsequent anemia. In such cases, careful patient selection is essential, and sometimes postponing or avoiding the procedure is the safest choice.
Early Mobilization
A simple yet highly effective preventive measure is early mobilization. Encouraging patients to walk on the day of surgery significantly reduces the risk of thrombosis. Movement improves blood flow in the legs, preventing stasis that can lead to clot formation.
Chemoprophylaxis
For patients at medium or high risk, chemoprophylaxis is a cornerstone of prevention. This involves using medications such as low molecular weight heparin (LMWH), which act on the coagulation cascade to reduce the likelihood of clot formation.
Coagulation is a complex biological process in which various biochemical factors interact to form a clot. Administering anticoagulants requires careful calculation of dosage and timing to maximize effectiveness while minimizing bleeding risk.
Integrating Preventive Measures
In practice, preventing thromboembolic events is a multifaceted approach. It includes:
- Risk assessment using the Caprini Scale
- Preoperative discontinuation of medications affecting coagulation
- Careful surgical planning to limit operative time
- Avoiding high-risk procedures in vulnerable patients
- Encouraging early postoperative mobility
- Administering chemoprophylaxis when indicated
When all these measures are implemented systematically, the incidence of thromboembolic events becomes very low, making surgery safer for patients across all age groups and risk categories.
Conclusion
Preventing thromboembolic events is a critical component of modern surgical care. By combining careful risk assessment, preoperative preparation, early mobilization, and chemoprophylaxis, surgeons can significantly reduce the likelihood of complications such as DVT and pulmonary embolism.
Through consistent application of these protocols, thromboembolic events have become increasingly rare in daily surgical practice, ensuring better outcomes and safer experiences for patients.
