Pre-op screening for DVT urged

Deep vein thrombosis (DVT) occurs in more than 20% of surgical patients and over 40% of patients undergoing major orthopaedic surgery.

Most of these thromboses are minor and cause no symptoms, but if the blood clot becomes loose it can travel in the blood stream to the lungs and cause a pulmonary embolism, which can prove fatal.

Pulmonary embolism following lower limb DVT is the cause of death in 10% of patients who die in hospital, many of them after surgery. The National Institute for Health and Clinical Excellence (Nice) proposed a three-step strategy to reduce the risk of such venous thromboembolism (VTE).

DVT specialist nurse Kim Carter, a Guideline Development Group member, said: "Provision of adequate protection against potentially life-threatening blood clots in surgical patients is currently variable.

"This guideline should ensure that all patients are fully assessed for their risk of VTE and offered the form of protection that is most appropriate for them."

The strategy recommends that all patients undergoing surgery requiring an overnight stay in hospital be assessed for their risk of VTE on admission. The degree of risk they face can be linked to factors such as obesity and long-term heart or lung problems, as well as the type of operation being carried out.

The suggestions for preventing blood clots include offering compression stockings to patients - and inflatable "boots" during the operation - and the use of blood thinning medication, such as fondaparinux, among "high risk" patients.

Where feasible, the guidelines also suggest local anaesthesia should be used instead of general anasthesia to further reduce risk of VTE. Patients should also be encouraged to mobilise as soon as possible after surgery. David Farrell, a patient representative on the Guideline Development Group, said: "Had this guideline been available when I underwent surgery on my knee, I may not have developed the blood clot that resulted in an unnecessary stint in hospital and took six months to recover from."

Nice will be working with the VTE Implementation Group established by the Chief Medical Officer to ensure the new proposals are brought in quickly. The guidelines were produced for Nice by the National Collaborating Centre for Acute Care, based on the most comprehensive review of the available evidence on ways to reduce the risk of VTE yet carried out.