To assess Danish surgical departments' attitudes to and clinical guidelines on the use of perioperative thrombo-prophylaxis (TP).
Questionnaires regarding TP were sent to Danish departments which ...performed major surgery in 2005. The questionnaires contained questions regarding the use of TP routinely after clinical guidelines for both elective and acute surgery, indications for the use of TP, the type of TP and the duration of the TP treatment. The results are registered descriptively. The results are compared with five previously performed surveys from 1981-2000.
In the five surveys from 1981 to 2000, 85%, 90%, 92%, 95%, 93% answered the questionnaire, in the present survey 88% answered. Since the beginning of these surveys, there has been a significant increase in the use of TP following clinical guidelines from approximately 50% in 1981 to 96% of the departments performing major surgery in 2005. In acute surgery we found a significant increase in the number of departments using TP following clinical guidelines from 43% in 2000 to 81% in 2005 (p<0.01 Fishers exact test). All departments that used TP employed low molecular weight heparin. The use of prolonged TP was sporadic.
30 years after the first evidence in favour of TP was published, 96% of surgical departments which perform major surgery use TP routinely based on international clinical recommendations. A large number of departments use TP in connection with acute surgery in comparison with previous surveys. A future task is more focus on the use of prolonged TP after major surgical procedures.
Objective: To evaluate colour Doppler flow imaging ultrasonography (CDFI), compared with venography, as a screening method for postoperative deep venous thrombosis (DVT) in a clinical trial on ...thromboprophylaxis.
Methods: Patients undergoing major abdominal or thoracic surgery were prospectively screened for DVT by CDFI. Patients were examined preoperatively, and on postoperative days 1, 3, 7, 14, 21, and 28. When the CDFI was positive venography was performed. Bilateral venography was performed on day 28 in all patients. The study group comprised 82 patients who underwent CDFI and venography on the same day: four because of suspected DVT (positive CDFI), and 78 on day 28 according to protocol.
Results: DVT was detected by venography in seven patients, in three of whom CDFI was positive. CDFI was falsely positive in one case. There were two popliteal and five calf DVTs, of which CDFI detected one and two, respectively. The sensitivity of CDFI was 43%, the specificity 99%. The PVpos for CDFI was 75%, and the PVneg 96%.
Conclusion: Due to low sensitivity, CDFI cannot stand alone as a screening method for asymptomatic postoperative DVT.
Survey of blood bank physicians and medical directors Shively, J A; Grove-Rasmussen, M; Hummer, G J ...
JAMA : the journal of the American Medical Association,
1971-Aug-23, Letnik:
217, Številka:
8
Journal Article
Venous thromboembolism (VTE) constitutes a major risk factor in hospitalized acutely ill medical patients. It has been demonstrated in numerous papers that by using different forms of prophylaxis, a ...significant reduction of the incidence of VTE can be achieved. In this article we assessed the tendencies in the use of venous thromboprophylaxis (TP) at internal medicine departments in Denmark. The results were compared with results from a similar study conducted in 2005.
All medical departments in Denmark received a two-page questionnaire on TP. The recipients were asked to evaluate the frequency, use of local instructions, form of administration, side-effects and duration of TP at their departments. One reminder was sent out.
A total of 188 responses were received (90% response rate), 16 were excluded. Virtually all departments indicated that they used TP (92%). At intensive care units, the TP was used according to local guidelines at 77% of the wards and at the other subspecialties of internal medicine, TP was used in less than 50%. By far the most frequently used prophylaxis method was low molecular weight heparin, which was used by more than 80% of the departments. Side-effects, most often superficial bleeding and haematomas, were reported in 25% of the cases. The following serious side-effects were reported: heparininduced thrombocytopenia (n = 2), stroke (n = 1) and gastrointestinal bleeding (n = 3). No difference was observed between the hospitals of larger cities and those of smaller cities.
In Denmark, no significant increase in the use of TP at internal medicine departments has been observed since 2005. The guideline's strong recommendation of TP is still not reflected in daily practice.
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