Risk-based evaluation of thromboprophylaxis among surgical inpatients: are low risk patients treated unnecessarily?
BACKGROUND
Venous thromboembolism is a common source of morbidity and mortality but a variety of preventative measures are available.


OBJECTIVE
To audit the current practice of thromboprophylaxis and compare against published protocols.


METHODS
Three-hundred and seventy-six (376) surgical patients were surveyed prospectively. A Performa was completed recording the presence of up to 11 risk factors. A risk score was calculated and the use of specific thromboprophylatic measures identified.


RESULTS
Heparin thromboprophylaxis was widely used, eight patients (who were on aspirin therapy) failed to receive any prophylaxis (risk factors 4-6). In addition there were 60 patients at low risk (risk score <2) received LMWH from which they were unlikely to benefit.


CONCLUSIONS
Thromboembolic prophylaxis is widely but unselectively applied. Adoption of a risk: benefit ratio approach should ensure those who would benefit from thromboprophylaxis are adequately treated while those in whom thromboprophylaxis is not indicated are spared unnecessary therapy.
Roche-Nagle
G
G
Department of Surgery, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin 9, Ireland. grnagle@rcsi.ie
Curran
J
J
Bouchier-Hayes
D J
DJ
Tierney
S
S
D002985:Clinical Protocols; D006801:Humans; D007297:Inpatients; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control*