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INTRODUCTION
The goal of every clinician is to deliver high quality
evidence-based care to their patients. One of the factors which subvert the
optimal post-operative outcome in the surgical patient is the development of
venous thromboembolism (VTE) either as deep vein thrombosis (DVT) or its more
fatal complication, the pulmonary embolism (PE).
Venous thromboembolism refers to blood clot formation within
the venous circulation. It could manifest as superficial thrombophlebitis, deep
vein thrombosis (DVT) or as pulmonary embolism (PE).
Deep vein thrombosis (DVT) is blood clot within the deep
veins of the calf, thigh, pelvis or less commonly the arm or neck.
Pulmonary embolism develops when a clot detaches from a DVT
and migrates to occlude the blood vessels of the lung.
Clinically, the practice of primary thromboprophylaxis,
which are measures taken to prevent venous thrombosis, is directed at both DVT
and PE but not superficial thrombophlebitis which is a less severe form of venous
thrombosis within the superficial veins.
The prevention of VTE is the number one strategy to improve
patient care according to the United States Agency for Health Care Research and
Quality.1
The scope of this article is VTE and thromboprophylaxis in
general surgery patients.
EPIDEMIOLOGY
Venous thromboembolism (VTE) is a very common public health
problem. It is an important preventable cause for morbidity and mortality among
patients who
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undergo general surgery.2
Several studies have identified PE as the most common
preventable cause of hospital deaths.3, 4, 5
It's estimated that 1-2 of every 1,000 Americans are
diagnosed with VTE every year.
Furthermore, 60,000 - 100,000
Americans die of venous thrombosis annually. More Americans die from VTE each
year than from acquired immune deficiency syndrome (AIDS) and breast cancer
combined.6
In Europe, the total annual
burden of VTE across the 25 member states of the European Union (before
Brexit), with a population of 454 million, was estimated to be 640,000 symptomatic
cases of DVT and 383,000 PE. VTE –related deaths were estimated at 480,000
annually. In the United Kingdom (UK) with 60 million inhabitants, an estimated
60,000 people die from preventable hospital acquired VTE every year.7
With regards to the surgical
patient, VTE is one of the more common complications seen in patients following
surgery, cancer, trauma or prolonged immobilization.8
Deep vein thrombosis (DVT) has been estimated to occur in up
to 40% of postoperative patients without thromboprophylaxis.9 The
morbidity and mortality associated with thromboembolic events is high, with
28-day fatality rates reported as 9% for DVT and 15% for pulmonary embolism
(PE).10, 11
Although the data on this
disease in Africa is scanty, a meta-analysis of studies reported by Danwang et
al showed a post-operative DVT prevalence of 2.4% - 9.6% and a case-fatality
rate of 60% from pulmonary embolism (PE) among surgical patients across various
centres in the African continent.12 They also observed that at least
one
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