Risk of VTE in Surgical Patients

VTE in major orthopaedic surgery

Major orthopaedic surgery involving the lower extremity — hip or knee replacement surgery or hip fracture surgery — is associated with a high risk of venous thromboembolism (VTE). The risk results from stasis of venous blood flow as well as direct injury to the veins during surgery.43
VTE is the most frequent serious complication following hip and knee replacement surgery. And it is the most common cause for rehospitalisation in this patient group.6, 50
Undertreatment remains a problem, despite ample evidence that primary preventive therapy effectively reduces the risk of deep vein thrombosis (DVT), pulmonary embolism (PE), and fatal PE.6, 7

Risk of VTE in general surgery

The risk of DVT in patients undergoing general surgery without thromboprophylaxis is 15% to 30%; the risk of fatal PE in this same group is approximately 0.08%. Duration and type of surgery affect thrombosis risk, as do increasing age and other risk factors like cancer, prior VTE, and obesity.44

Risk of VTE in major gynaecologic, open urologic, and neurologic surgeries

Major gynaecologic surgery poses a VTE risk that is comparable to the risk involved in general abdominal surgery (15% to 30% without preventive therapy). Major open urologic procedures confer significant risk, but transurethral procedures do not.6, 51 Venographic studies in patients undergoing neurosurgery show a rate of DVT of approximately 30%. The risks are increased in cranial surgery compared to spinal surgery, in cases of malignant tumours compared to cases of benign tumours, and in patients with leg weakness.45

Risk of VTE in cancer surgery

Cancer confers an increased risk of VTE. Accordingly, it is not surprising that the frequency of VTE in patients undergoing cancer surgery is roughly twice that seen in patients without malignancies who have comparable operations.44

Challenges in selecting optimal therapy

For abdominal surgery, where the risk of VTE is generally lower than in major orthopaedic surgery, low-dose unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), or fondaparinux can be used. Mechanical devices are an appropriate option in patients at high risk of bleeding complications and can be used as an adjunct to anticoagulation in other surgical patients.6

Learn more about venous thromboembolism with our Animated Thrombosis Overviews

VTE Risk in Medical Patients >
  • 43 - Merli GJ. Pathophysiology of venous thrombosis, thrombophilia, and the diagnosis of deep vein thrombosis-pulmonary embolism in the elderly. Clin Geriatr Med. 2006;22(1):75-92.
  • 6 - Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 suppl):381S-453S.
  • 50 - Harkess JW. Arthroplasty of hip. In: Canale ST, ed. Campbell’s Operative Orthopedics. 10th ed. Philadelphia, PA: Mosby, Inc; 2003. www.mdconsult.com. Accessed 12 February 2008.
  • 7 - Cohen AT, Tapson VF, Bergmann JF, et al; ENDORSE Investigators. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371(9610):387-394.
  • 44 - Kakkar AK. Prevention of venous thromboembolism in general surgery. In: Colman RW, Clowes AW, George JN, Goldhaber SZ, Marder VJ, eds. Hemostasis and Thrombosis: Basic Principles and Clinical Practice. 5th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2006:1361-1367.
  • 51 - Nicolaides AN, Fareed J, Kakkar AK, et al. Prevention and treatment of venous thromboembolism. International Consensus Statement (guidelines according to scientific evidence). Int Angiol. 2006;25(2):101-161.
  • 45 - Motte S, Samama CM, Guay J, Barré J, Borg JY, Rosencher N. Prevention of postoperative venous thromboembolism. Risk assessment and methods of prophylaxis. Can J Anaesth. 2006;53(6 suppl):S68-S79.
Major orthopaedic surgery
Major operations on the bones or joints including total hip or knee replacement surgery.
Venous thromboembolism
A disease process beginning with a blood clot occurring within the venous system, including deep vein thrombosis and pulmonary embolism.
Thrombosis
Formation of a clot inside a blood vessel.
Pulmonary embolism
A potentially fatal condition caused by a blood clot blocking a vessel in the lung: usually the clot originates from a DVT in the legs. PE can result in permanent lung damage.
Thromboprophylaxis
Preventative treatment for blood clotting.
Deep vein thrombosis
A blood clot in a deep vein, usually resulting from damage to the vein or blood flow slowing down or stopping. Usually DVTs are found in the leg, but can also be in the arm. Distal DVTs are found in deep veins of the calf, and are the most common type of DVT. Proximal DVTs are found in the legs above the calf muscle up to the waist.