Venous thromboembolism remains a leading preventable cause of death after surgery, and the step most often missed is not the prescription but the assessment that should trigger it. A documented risk assessment on admission, repeated if the clinical picture changes, is what turns prophylaxis from ad hoc to reliable.
Weigh the procedure and patient risk against bleeding risk. Use mechanical prophylaxis — early mobilisation and intermittent pneumatic compression — for most, and add pharmacological prophylaxis where the thrombotic risk outweighs bleeding and there is no contraindication.
Set the duration deliberately: major abdominal and pelvic cancer surgery often warrants extended prophylaxis after discharge. Record the plan so the ward and the patient both know it.
- Document a venous thromboembolism risk assessment on admission and repeat it if the clinical picture changes.
- Give mechanical prophylaxis for most, including early mobilisation and intermittent pneumatic compression.
- Add pharmacological prophylaxis where thrombotic risk outweighs bleeding and there is no contraindication.
- Consider extended prophylaxis after major abdominal or pelvic cancer surgery.
Why it matters
Postoperative venous thromboembolism is a leading preventable cause of death, and the assessment that should trigger prophylaxis is the step most often skipped.
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