Wasim Mirza, Samie Ashraf, Ahmad Fawad.
Role of routine use of thromboprophylaxis in patients undergoing major surgery.
Pak J Med Res Jan ;44(1):4-11.

Background: Routine use of thromboprophylaxis in patients undergoing major General Surgical, Pelvic and Hip Surgery is not an established norm in Pakistan, as Venous Thromboembolism is generally considered almost non-existent in this part of the world. As very little research data regarding prevalence/incidence of DVT and PE are available so far in this country, the need for more research cannot be over emphasized. This would help to evaluate the true risk of VTE and suggest the best mode of prophylaxis. Methodology: Eighty-four surgical patients were randomly selected for this trial. All of them underwent bilateral Doppler sonographical examination of the lower extremities between 7th to 10th post-operative days and later followed up to 30th post-operative days for any clinical evidence of DVT or PE. They were also randomized into three equal sub-groups; A, B and C. Those in group-A (control group) received no prophylaxis, those in group-B was provided with only physical therapy and those in group-C were given both Physical as well as Pharmacological prophylaxis. The results of scanning and clinical outcomes were properly documented for accurate evaluation. Result: Deep vein thrombosis was diagnosed in three out of eighty four (3.57%) patients. As all Doppler positive patients belonged to the control group (A) only, the relative percentage of DVT among those who did not receive any form of prophylaxis was thus 10.71%. None of the patients belonging to either Group-B or C showed any clinical or sonological evidence of DVT when followed up to one month post-operatively. One Doppler positive patient suffered an acute attack of PE (diagnosed clinically) and expired by the end of third post-operative month. Conclusion: Deep vein thrombosis is not a rarity in Pakistan, as is generally believed. Routine use of thromboprophylaxis is strongly recommended in all high risk surgical patients; in particular, those aged over forty years undergoing major surgical procedures.

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