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Venous Thromboembolism in Surgical Patients

Venous Thromboembolism in Surgical Patients

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29 September 2022

RCSEd Communications Team

As part of a series of blog posts surrounding World Patient Safety Day 2022's theme of 'Medication Safety', Miss Fatima Mansour discusses venous thromboembolism in surgical patients.

Venous thrombo-embolism (VTE) is characterised by two disease entities, deep vein thrombosis and pulmonary embolism. Worldwide, it is one of the biggest causes of patient preventable harm, affecting 1 in 1000 people per annum.¹ Around 55-60% of VTEs develop within 90 days of hospital admission [1], and in the UK an estimated 25,000 patients die from preventable hospital-related VTEs per year.² Surgical patients are particularly susceptible, and without optimal prophylaxis are at 30% increased risk.³ Risk factors are said to include prolonged immobility, the surgical stress response and operation type (orthopaedic/abdomino-pelvic etc). VTE prophylaxis can significantly reduce patient harm, however there continues to be errors in risk assessment and administration to patients.

In an effort to improve uptake of thromboprophylaxis, reporting of VTE risk assessments became a mandatory requirement in the UK in 2010. New health policy coupled with financial sanctions have correlated with a 20.8% reduction in VTE-related mortality in England. This signifies noteworthy progress. However, Although an average of 95% of NHS adult admissions receive vte risk assessment, audits have suggested that only 74% are administered optimal therapy.³ The COVID pandemic has further added to the disease burden, with an incidence of VTE in up to 31% of critical care settings and potentially greater risk of VTE development in elective patients with perioperative SARS-CoV-2 infection.⁴

Further work is needed to continue reducing medication error in VTE management, namely ensuring uptake. Locally, we need to improve compliance with NICE guidance, including reassessment after change in patient condition, and automation of prolonged prophylaxis for certain conditions. There also needs to be greater research into the effects of established therapies such as below knee stockings. In such a common ailment, it is crucial that our management is based on a strong evidence base, and that greater efforts are made to reduce medication omission errors.

Heit J. The Epidemiology of Venous Thromboembolism in the Community. Arteriosclerosis, Thrombosis, and Vascular Biology. 2008;28(3):370-372.
House of Commons Health Committee (2005). The prevention of venous thromboembolism in hospitalised patients, London:The Stationery Office.
Cohen A, Tapson V, Bergmann J, Goldhaber S, Kakkar A, Deslandes B et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. The Lancet. 2008;371(9610):387-394.
Nepogodiev D, Simoes J, Li E, Picciochi M, Glasbey J, Baiocchi G et al. SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study. Anaesthesia. 2021;77(1):28-39.

Fatima Mansour is an ST5 Speciality Registrar in General Surgery, in the West Midlands. She is currently the WEISS Clinical Research Fellow in HPB and liver transplantation at the Royal Free Hospital. She is working towards her PhD at University College London. Fatima is a trainee committee member at the Royal College of Surgeons Edinburgh and is the trainee representative for the Patient Safety group. Outside of clinical practice, her interests include surgical education, trainee collaborative research and quality improvement for patient safety.

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