Effective implementation of thromboprophylaxis strategiesBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39226.454236.3A (Published 31 May 2007) Cite this as: BMJ 2007;334:1128
- Christian Schwiebert, specialist registrar anaesthesia, Imperial School, Royal Brompton Hospital, London SW3 6NP,
- Barry G Lambert, specialist registrar anaesthesia, Imperial School, Queen Charlotte's Hospital, London W12 0HS
We agree with Fitzmaurice and Murray that the risks to patients of developing thromboembolism after surgery are well understood by clinicians.1 But the challenge of providing the recommended 100% compliance of prophylactic measures is substantial and can be met only by coordinated hospital wide strategies.
We recently completed an audit of thromboprophylaxis for surgical patients at a major oncological centre. Despite a high awareness of the risks, over 50% of our patients were not receiving their risk appropriate prescriptions of low molecular weight heparin. Correct use of mechanical prophylaxis was achieved in over 80% of patients. The practice of thromboprophylaxis varied substantially between different clinicians. Often no clearly designated doctor, surgeon, or anaesthetist was responsible in the team for implementing prophylaxis.
Patients should be classified into the risk categories suggested by the National Institute for Health and Clinical Excellence (NICE) at the earliest opportunity, such as in pre-assessment clinics, with local hospital protocols suggesting the most suitable prophylactic strategy and who should implement it. This will give a greater number of patients the benefit of evidence based risk reduction.
Competing interests: None declared.