Deep Vein Thrombosis:DVT is usually the formation of a thrombus in the deep veins of the leg, and may be referred to as proximal DVT or distal DVT. Occasionally, DVT also occurs in the veins of the upper extremities. DVT can occur spontaneously without known underlying cause (idiopathic thrombosis) or after provoking events, such as trauma, surgery or acute illness (provoked thrombosis).
I have no theoretical info, but after my last great operation, I started to walk around at the moment I woke up. Very hard but helpful.
Im interested in theoretical aspects.
A protocol which allowed patients to start walking at less than 24 hours after surgery was instituted in August 2002. Between August 2002 and November 2004, 97 patients underwent a total of 122 total knee replacements. They formed the early mobilisation group, in which data were prospectively gathered. The two groups were of similar age, gender and had similar medical comorbidities. The surgical technique and tourniquet times were similar and the same instrumentation was used in nearly all cases. All the patients received low-molecular-weight heparin thromboprophylaxis and wore compression stockings post-operatively. In the early mobilisation group 90 patients (92.8%) began walking successfully within 24 hours of their operation. The incidence of deep-vein thrombosis fell from 27.6% in the control group to 1.0% in the early mobilisation group (chi-squared test, p < 0.001). There was a difference in the incidence of risk factors for deep-vein thrombosis between the two groups. However, multiple logistic regression analysis showed that the institution of an early mobilisation protocol resulted in a 30-fold reduction in the risk of post-operative deep-vein thrombosis when we adjusted for other risk factors.
Source - Pearse et all (2007), Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism. J Bone Joint Surg Br. 2007 Mar;89(3):316-22
Is there a difference in embolism risk between warfarin and lovanox (self-administered by needle for 10 days after release)?
Prompt mobilization after the surgery is very beneficial for the prevention of deep vein thrombosis. The lower extremity deep veins conduct the blood upwards against the gravity. In order to overcome this negative force, the passive blood flow inside the veins should be supported with an external assistance of muscle contraction. As the deep veins of the limbs lie inside the muscles, they smoothly eject the blood forward with the contraction of the muscles, which is called as the "muscle pump". This prevents venous hypertension and formation of clots inside the veins. Thus, the patient should be mobilized as soon as possible following the surgery.
Thanks for all that info, Lawrence. George, I'm so glad you did make it!
Can you talk about the efficacy of daily use of compression stockings for people in risk of a repeat embolism?
Mobilisation immediately post surgery is the best solution for the prevention of VTE. Anticoagulation is necessary as well. All risk factors and treatments are correctly mentioned above.
After General Thoracic Surgery the risk could be reduced, and according to our experience we suggest using immediate postoperative mobilisation, low molecular weight heparin (LMWH) and compressive stockings.
As soon as it is possible post op, that is to the extent pain can allow. The earlier the better in preventing DVT, It become difficult to mobilize soon after lower limb surgeries which can be disturbed by movements or weight bearing. For this group, depending on other risk factors, compression bandaging, passive exercises with or without CPM machine and breathing exercises will help until patient starts bearing weight.
As soon as possible, to prevent deep vein thrombosis- hopefully in under 24 hours. Take into account other factors- sedation, analgesia, fall risk, nerve blocks, frailty as to when this is most appropriate.
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