The necessity of routine screening for deep vein thrombosis before surgery

• Published in: Annals of medicine and surgery Vol. 77; p. 103627
• Main Authors: Endoh, Hideki, Shiratori, Kazuaki, Horigome, Miki, Uematsu, Dai, Takehana, Takuo, Sakamoto, Taro, Fukushima, Kazuyuki, Ishige, Hiroyuki, Watanabe, Hitoshi, Yazaki, Yoshikazu
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2022; Elsevier
• Subjects: DVT; Experimental Research; Fondaparinux; Surgical management; Thromboprophylaxis; VTE; Surgical management; Thromboprophylaxis; DVT; VTE; Fondaparinux
• ISSN: 2049-0801; 2049-0801
• DOI: 10.1016/j.amsu.2022.103627

Pulmonary embolism (PE) from deep venous thrombosis (DVT) can be a fatal postoperative complication. Preventive measures for venous thromboembolism (VTE) was evaluated in this hospital. Preoperative DVT screening following surgery under general anesthesia in 2009–2016 was examined, and then, 217 patients diagnosed with DVT by preoperative leg-ultrasound (US) between 2014 and 2016 were retrospectively analyzed. There were 24,826 operations under general anesthesia in the study period. Preoperative leg-US was performed in 5345 (21.5%) patients, and 648 (12.1% of patients, 2.6% of total operations) were diagnosed with DVT. In 2014–2016, 217 patients, which is 11.7% of patients undergoing leg-US, were diagnosed with DVT. DVT was found in the proximal veins (upper popliteal vein) in 86 (39.6%) patients. A total of 143 (62%) patients were considered to have organized thrombi, no patient developed pulmonary embolism, and 133 (58%) patients were discharged without follow-up examination for DVT. Ninety-six patients were evaluated for changes on leg-US, with no difference in the results with and without anticoagulant use. On multivariate logistic regression analysis, anticoagulants appeared effective for non-organized thrombi, higher D-dimer levels (≥10 μg/mL), or orthopedic surgery. Preoperative screening for DVT did not appear useful, and treatment of asymptomatic DVT was not always necessary. •Preoperative screening of leg-ultrasound diagnosed 12% of patients with DVT.•Developing symptomatic embolism was not associated with anticoagulant use.•Anticoagulants were effective for non-organized thrombi, higher D-dimer levels, or orthopedic surgery.•Preoperative screening for DVT did not appear useful.