The waiting game:Thromboprophylaxis, are we getting it right - Essay Example

sty are at a high risk of developing a venous thromboembolism, pulmonary embolism and postphlebotic syndrome with several studies suggesting that the risk continues for several weeks [Scottish Intercollegiate Guidelines Network (SIGN) 2002, Hull et al 1999, Eikelboom et al 2001]. The silent nature of the disease and the notorious difficulty in clinical diagnosis, along with the high prevalence among orthopaedic patients, justifies the need for thromboprophylaxis (Zaw, Osborne, Pettit, and Cohen, 2002).

Deep vein thrombosis of the lower limbs is a common disease, often asymptomatic, but presenting with clinical symptoms (leg pain or swelling) in about 1 per 1,000 people per year in the general population. Complications include pulmonary thromboembolism and post-thrombotic leg syndrome (SIGN, 2002). Deep venous thrombosis has multiple causes such as orthopaedic surgery, trauma, immobilisation, use of a tourniquet, anaesthesia duration > 30 minutes, pregnancy, age (≥ 40 years), family history of deep venous thrombosis or pulmonary embolism, blood type O, ethnicity, inherited coagulation defects, obesity, cancer, oral contraception, and hormone replacement therapy, among others (Muntz, 2003).

Asymptomatic deep venous thrombosis is defined as deep venous thrombosis detected by screening with 125I fibrinogen scanning, ultrasound, or ascending venography. Symptomatic deep venous thrombosis (leg pain or swelling) results from occlusion of a major leg vein. It requires specific investigation and treatment which in-hospitalised patients may delay discharge, or require readmission to the hospital (SIGN, 2002). Pulmonary embolism, which in 90% of cases results from an asymptomatic deep venous thrombosis, may present as sudden death, breathlessness, faintness, collapse, or chest pain.

Nonfatal pulmonary embolism in hospitalised patients may delay discharge, or require readmission to the hospital. Fatal pulmonary embolism is under-diagnosed, because of the non-specificity of