POSTOPERATIVE THROMBOEMBOLISM - PREVENTIO N, DIAGNOSIS AND TREATMENT

Risk factors: There are two main types of risk factors for postoperati ve thromboembolism. Patient-related factors include a history of throm boembolism neoplasia, resistance to activated protein C and other coag ulation disorders. Factors related to the operative period comprise an other type of risk The high morbidity and mortality of this ''bipolar' ' disease involving both deep vein thrombosis and pulmonary emboli inc ites renewed efforts to reduce its incidence. Prophylaxis: The level o f risk Varies with each surgical procedure requiring case by case adap tation of the prophylaxis protocol. Low-molecular weight heparin has b een widely used. Diagnostic strategy: Since clinical expression is ins ufficiently sensitive and the risk persists despite adequate prophylax is, the question is raised as to the most appropriate means of diagnos is. Ongoing progress in technical tools including duplex Doppler of th e lower limbs and spiral scan have greatly changed diagnostic strategi es. Noninvasive explorations have become the gold standard compared wi th invasive phlebography and pulmonary angiography. Therapeutic strate gy: Curative treatment, itself carrying a high risk of severe morbidit y, has also undergone significant changes. Oral anticoagulants remain the mainstay of long-term treatment but, on the basis of recent report s, low-molecular weight heparin has tended to replace standard heparin .