From the Guidelines
Surgery significantly increases the risk of deep vein thrombosis (DVT), with major operations, prolonged surgical time, general anesthesia, and extended bed rest during recovery being key contributing factors. According to the most recent and highest quality study, a 2024 study published in Thrombosis Research 1, major abdominopelvic surgery is an important risk factor for postoperative venous thromboembolism (VTE), including pulmonary embolism (PE) and DVT. The study found that postoperative hypercoagulability can persist for 30 days following major abdominopelvic surgery, highlighting the need for extended-duration thromboprophylaxis to decrease the burden of VTE in this patient population.
Some key risk factors for DVT after surgery include:
- Major open surgery (> 45 min) 1
- History of VTE 1
- Family history of VTE 1
- Factor V Leiden 1
- Prothrombin 20210A 1
- Lupus anticoagulant 1
- Anticardiolipin antibodies 1
- Elevated serum homocysteine 1
- Heparin-induced thrombocytopenia 1
- Other congenital or acquired thrombophilia 1
To prevent DVT after surgery, doctors often prescribe blood thinners like enoxaparin (Lovenox), heparin, or warfarin, typically starting before or immediately after surgery and continuing for days to weeks depending on risk factors 1. Mechanical prevention methods include compression stockings, intermittent pneumatic compression devices, and early mobilization. Patients should stay hydrated, move their legs frequently when confined to bed, and follow all post-surgical instructions regarding medication and activity. The risk of DVT is highest in the first two weeks after surgery but can persist for up to three months in high-risk cases.
The use of extended duration thromboprophylaxis for 30 days post surgery using low molecular weight heparin (LMWH) or a direct oral anticoagulant (DOAC) has been shown to significantly decrease the risk of overall VTE (Odds Ratio (OR): 0.38; 95 % confidence interval (CI): 0.28 to 0.54) and symptomatic VTE (OR: 0.30; 95%CI: 0.08 to 1.11) following major abdominopelvic surgery 1. Therefore, extended-duration thromboprophylaxis is recommended for all high-risk patients undergoing major abdominopelvic surgery.
From the Research
Risk of DVT after Surgery
- Surgery can increase the risk of Deep Vein Thrombosis (DVT) due to various factors such as immobilization, trauma, and hypercoagulability 2, 3, 4.
- Patients undergoing orthopedic surgery are at particular risk of DVT, with rates as high as 50% reported in the absence of prophylaxis 3.
- Other risk factors for postoperative DVT include increased age, obesity, past history of thromboembolism, varicose veins, and malignancy 3, 4.
Prevention of DVT after Surgery
- Pharmacological thromboprophylaxis is recommended to prevent DVT in patients undergoing orthopedic surgery, and can reduce the risk of venographically proven DVT 2, 3.
- Low-molecular-weight heparin (LMWH) is a commonly used prophylactic measure, and has been shown to be effective in reducing the risk of DVT and pulmonary embolism 5, 6.
- Other prophylactic measures include eliminating venous stasis and changing blood coagulability, such as through the use of compression stockings or intermittent pneumatic compression devices 4.