Do patients need thromboprophylaxis after day surgery
procedures?
Although patients having a day surgery procedure are
mobile within hours of their surgery they are known to be at risk
of venous thromboembolism(VTE) and NICE Guidance published in 2010
on reducing the risk of venous thromboembolism(VTE) specifically
recommends that all patients admitted for day surgery under general
anaesthetic should be risk assessed and consideration given to use
of mechanical and/or chemical thromboprophylaxis.
Since the NICE Guidance was originally published in 2010 the
range of procedures offered on a day case basis has extended
considerably and many procedures now take in excess of the 90
minutes considered to pose a risk for thromboembolism. The
patients who are able to benefit from day surgery now include many
patients with significant co morbidity such as a BMI > 30 and
age > 60 years, both of which are considered a risk for VTE (see
Box). However work presented at BADS ASM over the last few
years suggests that nationally the majority of patients having day
surgery procedures are not given 5-7 days heparin postoperatively
but are managed with compression stockings, early mobilisation and
prevention of dehydration and that the incidence of VTE in
patients having day surgery is apparently low ii, iii. So,
how should thromboprophylaxis be managed for patients having day
surgery?
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