Wasim Mirza, Samie Ashraf, Ahmad Fawad.
Physical versus combined physical and pharmacological prophylaxis against Deep Vein Thrombosis in patients undergoing major surgery.
J Rawal Med Coll Jan ;9(1):12-7.

Background: Patients undergoing major surgery, especially those over 40 years, are considered to be high-risk candidates for venous thromboembolism (VTE). In practice, Pharmacological Prophylaxis is usually preferred over Physical Prophylaxis, but the latter offers far better safety profile. The present study was designed to compare the efficacy of Physical Prophylaxis alone with that of Combined Physical and Chemical Prophylaxis. Methods: In this prospective randomised study, 84 patients were randomised into three equal groups: A, B and C. Patients in Group-A (Control Group) were provided with no prophylaxis, those in Group-B were given only physical prophylaxis i.e. specific lower extremity exercises (LEE) and Intermittent Manual Calf Compression (IMCC) while those in Group-C were administered Low Molecular Weight Heparin (LMWH) e.g. enoxaparin as well as physical therapy. Demographic data and clinical outcomes were recorded in specially designed Clinical Data Forms. All patients underwent bilateral Doppler ultrasonography of both lower extremities between 7th to 10th post-operative days and were followed up to 30th post-operative day for any clinical evidence of DVT or pulmonary embolism. Result: Deep Vein Thrombosis was diagnosed in 3.57% (n: 3) patients in the whole study population. All patients presenting with ultrasonological evidence of DVT belonged to Group-A. The prevalence of DVT in the control group was therefore 10.71%. None of the patients in Group-B or C showed- any positive clinical or sonological evidence of VTE. In one patient LMWH therapy had to be discontinued after 48 hours due to excessive and unexpected bleeding. Conclusion: Physical prophylaxis, even when manually employed, appears to be almost as effective as combined Physical and Pharmacological prophylaxis in patients belonging to any risk group. Physical therapy is not only a safer option but also completely cost free.

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