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Category: Volume 07 Issue 08 August 2019
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Title: Study the incidence of postoperative deep vein thrombosis in high and moderate risk patients’ in general surgical ward in a tertiary care teaching hospital, Bihar

Authors: Dr Ved Arya, Dr Saurabh Kumar, Dr Abinav Singh, Dr Aditya Anand, Dr Pranaya Kunal

 DOI: https://dx.doi.org/10.18535/jmscr/v7i8.07

Abstract

Background: Deep vein thrombosis by definition is formation of blood clot within the deep veins. These are a major cause of morbidity and mortality in patients undergoing major abdominal and orthopedic surgery 18 months of study was done. High or moderate risk of deep vein thrombosis admitted in General Surgery ward.

Methods & Patients: About 75 patients among the 82 screened, completed the study protocol. Patients fulfilling the selection criteria and having DVT on the screening (within 7days of admission) Duplex ultrasonography (DUS), and those diagnosed with chronic DVT are excluded from the study population. Patient already on anticoagulation or on antiplatelet medications are also excluded. Duplex USG of both the lower limb deep venous system –including bilateral external iliac, common femoral, superficial femoral, popliteal and anterior and posterior tibial veins, calf veins and to look for the followings: inability to compress the vein, lack of spontaneous flow, loss of respiratory flow variation, venous distention, absence of colour filling of lumen by Color Doppler, patient being examined in supine posture. Presence of these features was taken as positive for presence of DVT. First one being was done preoperatively (7 days of admission), and the next one at discharge (as soon as the patient is mobilized).

Results: There were 5 deaths and 2 dropouts. In a total 47 patients [developed malignancies for different reasons] colorectal carcinoma was 23 [48.94%], followed by metastatic disease 10 [21.27%] and periampullary carcinoma and carcinoma gallbladder 4 [8.51%]. Average overall (preoperative postoperative) immobility was 5.31 days. Majority of the study subjects were immobile for 1-5 days 58 (77.33%) in postoperative phase. About 57 (76%) of the subjects were immobile in preoperative phase. None of the cases were reported to be immobile during pre or post operative phase. Four of the deaths were documented as due to sepsis and MODS, one due to acute myocardial infarction. None of the patients who died had any clinical features of pulmonary emboli or DVT.

Conclusion: Complications must be anticipated, and preventive actions must be taken in every surgical case. Early recognition with prompt appropriate intervention is the best way to prevent progression to a potentially disastrous situation. We opine that the employment of thrombo-prophylaxis may be advocated for patients with cancers undergoing prolonged surgical procedures or patients being immobilized for prolonged duration after the procedure. In other patients the cost-effective alternatives of early ambulation as well as mechanical prophylaxis might be employed to reduce the development of VTE.

Keywords: Venous thromboembolic events, deep vein thrombosis, pulmonary embolism, postoperative, thrombo-prophylaxis, Surgery Ward.

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Corresponding Author

Dr Saurabh Kumar

Assistant Professor, Department of General Surgery, Mata Gujri Memorial Medical College & Lions Seva Kendra Hospital, Kishanganj, Bihar- 855107, India