A survey of deep venous thrombosis management by consultant vascular surgeons in the United Kingdom and Ireland

Thromboprophylaxis can be omitted in selected patients undergoing varicose vein surgery and hernia repair

BACKGROUND

There is no current agreement on the routine use of thromboprophylaxis in patients undergoing varicose vein surgery and hernia repair. In the authors' hospital, prophylaxis is given only to those considered to be at an increased risk. A retrospective review was conducted to determine whether it was safe to omit prophylaxis in low-risk patients.

METHODS

Data were extracted from the hospital database about all patients who underwent the above procedures between January 1997 and December 2001. The case notes of patients who developed venous thromboembolism (VTE) within 3 months of surgery were reviewed. The pharmacy database was then analysed to determine the effect of prophylaxis.

RESULTS

A total of 4670 patients were identified. Some 2186 patients had varicose vein surgery; 1283 patients received prophylaxis, of whom four developed VTE. None of the 903 patients who did not receive prophylaxis developed VTE. A total of 2484 patients had hernia repair, of whom 1854 patients received prophylaxis and 630 did not; one patient from each group developed VTE.

CONCLUSION

Low-risk patients having hernia and vein surgery do not need thromboprophylaxis.

Thrombophilia and chronic venous ulceration

It is known that thrombophilia (TP) is a risk factor for deep venous thrombosis (DVT), and that DVT predisposes to chronic venous ulceration (CVU). However, the relationship between TP and CVU has not been well studied. Review of the literature reveals that the prevalence of TP in CVU patients is high--similar to the prevalence found in patients with a history of DVT. This is despite many patients with CVU having no clear history, or duplex evidence of previous DVT. TP may predispose to CVU by leading to macro- or micro-vascular thrombosis. This association raises several issues regarding the investigation, prevention and management of patients with venous disease.