SHOULD POSTOPERATIVE PROPHYLAXIS OF THROM BOEMBOLISM BE EXTENDED TO THE POSTHOSPITAL PHASE

A large number of patients medically treated for deep vein thrombosis and pulmonary embolism have a history of surgery in the immediate past . We therefore enquired whether it is possible to identify specific ri sk factors which would allow general recommendations for anticoagulati on therapy in the postdischarge period. During the 30-month study peri od 325 patients were treated at the Cantonal Hospital, Aarau, for DVT and/or pulmonary embolism. 35 (10.8%) had undergone surgery 8 weeks pr evious to admission. Perioperative management (anticoagulation, chrono logy, mobility etc.) was analyzed retrospectively. 20% of the 35 patie nts with postdischarge deep vein thrombosis and/or pulmonary embolism had previously undergone an ambulatory surgical procedure. A large num ber of thromboembolic complications occurred between the 4th and 12th day after discharge. In 40% of the patients, however, they occurred af ter the 14th posthospital day. High- and low-risk patients were imposs ible to define on the basis of the type of surgery, length of hospital stay and time course of thromboembolic complications. We conclude tha t prophylaxis of thromboembolism in ambulatory surgery should be retho ught: patients undergoing arthroscopy should receive prophylaxis for t hromboembolism for at least 4-6 weeks post discharge.