Vascular Disease Prevention, 2005, 2, 311-315 311 1567-2700/05 $50.00+.00 © 2005 Bentham Science Publishers Ltd. Overview of Current Practice and Future Trends in Thromboprophylaxis for General Surgery C. Hee*, A. Singh, F. Tudor, K. Akinola and A.T. Cohen Vascular Diseases Research Group, Department of Surgery, King’s Denmark Hill Campus, Bessemer Road, London SE5 9PJ, UK Abstract: Deep vein thrombosis (DVT) poses a threat in patients undergoing major operations especially, abdominal sur- gery. Hence, it is a well established, to use thromboprophylaxis for these patients. We provide an overview of the current practices and the future advancement of DVT prophylaxis. INTRODUCTION Patients undergoing general surgery have an estimated risk of between 20 to 25% of developing deep vein thrombo- sis (DVT) according to data from randomised controlled trials [1]. General surgery encompasses a broad spectrum of operations and specialities with different risks of DVT as outlined in Table 1. The incidence of DVT in surgical pa- tients is influenced by pre-existing factors (Table 2). Patients without risk factors for venous thrombo embolism (VTE) are considered to be at low risk while those with risk factors such as cancer are at substantial risk [2-3] (Table 3). Trials on high-risk patients showed an incidence of VTE events between 9 and 18 % [5-7] despite receiving appropri- ate prophylaxis with unfractionated heparin (UFH) or low- molecular-weight heparins (LMWHs). This frequency is at least twice that observed in general surgical patients of all risk levels receiving prophylaxis. VTE is the commonest complication and the second most common cause of death in patients with malignancy [8,9]. VTE is often silent and difficult to diagnose. VTE causes around one third of re-admissions to hospital and the cumu- lative recurrence of DVT after eight years is 30.3%, while post-thrombotic syndrome after eight years is 29.1% [10]. This all contributes a high degree of morbidity, a decrease in quality of life and exerts a great financial burden upon the health service. Thus, thromboprophylaxis in general surgery is considered as a cost effective means of reducing post- operative VTE complications. CURRENT TRENDS FOR VTE PREVENTION IN GENERAL SURGERY Thromboprophylaxis can be achieved by mechanical and pharmacological methods. MECHANICAL METHODS The most popular mechanical methods include elastic stockings (ES) and intermittent pneumatic compression *Address correspondence to this author at the Vascular Diseases Research Group, Department of Surgery, King’s Denmark Hill Campus, Bessemer Road, London SE5 9PJ, UK.; Tel: +44 (0) 020-7346-3015/3036; Fax: +44 (0) 020-7346-3927/3866; E-mail: chrishee88@hotmail.com (IPC). They are thought to work by preventing venous stasis and increasing venous return. Table 1. The Frequency of DVT Diagnosed by the I 125 Fi- brinogen Uptake Test (Modified from Bergqvist D. 1983) [30] General abdominal 30% General surgery for malignancy 40% Thoracic surgery Malignancy 45% Other non-cardiac 30% Cardiac 30% Gynaecological surgery 25% Urological surgery Transverse prostatectomy 12% TURP 10% Herniorraphy 5% IPC is an attractive method of prophylaxis because of the zero risk of haemorrhagic complications. However, only a few small studies demonstrated that IPC is effective in re- ducing DVT in general surgical patients and in those with malignancy [11-13]. In trials comparing IPC and UFH, both agents produced similar reductions in DVT [14-15]. How- ever, it is still not proven that IPC prevents pulmonary em- bolism (PE) in surgical patients. ES may have an important role in situations where ve- nous stasis and return are compromised, such as during ab- dominal insufflation for laparascopic procedures [17,18]. ES reduce the incidence of DVT [19] and may enhance the pro- tection provided by UFH when used together, especially following major abdominal surgery [20,21]. Their major contraindications include peripheral arterial disease, (since blood flow would be further restricted when tight stockings are applied), peripheral oedema and dermatitis. Disadvan-