Assessment of deep vein thrombosis prophylaxis in surgical patients: a study conducted at Nancy University Hospital, France

Objective: This retrospective evaluation aimed to assess the adequacy of pr ophylaxis against thromboembolism prescribed to surgical patients at the au thors' institution, and to compare it with generally accepted published gui delines. Aspects considered were indications for prophylaxis, regimens used and monitoring. Methods: Eleven units (nine surgical and two surgical intensive care) took part in the survey on a voluntary basis. The clinical audit system used inv olved developing a set of criteria based on existing guidelines, comparing observed practice with those recommendations, analysing the factors underly ing any deviation and developing corrective measures. Results: When the medical records of 117 patients hospitalized in October 1 995 were examined, prophylaxis against deep vein thrombosis was documented in 86 (low molecular weight heparin in 85, dextran in one). No associated p hysical preventative measures were recorded. Indications and dosage were ap propriately handled in 90.7% and 75.2% of patients, respectively. Ninety-fi ve cases were outside the reference criteria: 74 for excluded surgical indi cations, 13 which involved laparoscopy, and eight in which spinal or epidur al anaesthesia was administered. Platelet count was performed in 73.8% of c ases before prophylactic treatment, and in 23.1% during its course. Anti-Xa activity was measured in 0.4% of cases. Analysis of causes showed that gui delines were not complied with either because of lack of organization, or b ecause of disagreement with them. Discussion: In this study, indications for prophylaxis were well establishe d and heparin dosages used were not fundamentally flawed. The weak point in practice was a failure to carry out platelet counts, particularly during t he course of treatment. Appropriate corrective action consists of dissemina ting guidelines and relevant information, and using a preoperative checklis t to assess thromboembolic risk. Conclusion: Physicians agree that opportunities to improve preventative pra ctices exist, and that the quality improvement programme should be pursued.