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Title: The prevention of post-operative deep vein thrombosis
Author: Howard, Adam Quentin
ISNI:       0000 0001 3582 4454
Awarding Body: Imperial College London (University of London)
Current Institution: Imperial College London
Date of Award: 2007
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Background: In a university hospital, disparate and unsatisfactory thromboprophylaxis in surgical patients was found. No hospital consensus was in place for the prevention of postoperative deep vein thrombosis (DVT). Literature review suggested low molecular weight heparin (LMWH) and anti-embolic stockings were the best prophylaxis, however the optimal length of stocking was unknown. Method: Audit of thromboprophylaxis in surgical patients and surgical doctors was performed. A randomised controlled trial investigated the efficacy and safety of a new single protocol of LMWH and the best length of stocking, for every patient requiring surgery under general anaesthesia. Of 426 patients interviewed, 376 were randomised into three stocking groups, Medi Thrombexin® Climax™ thigh-length, Thrombexin® Climax™ knee-length and Kendall TEDTM thigh-length. All patients received LMWH. DVT incidence was assessed by duplex ultrasonography. Complications of thromboprophylaxis were recorded. Compliance and health outcome measures were developed to assess patient stocking acceptability. Results: Audit revealed inadequate surgical thromboprophylaxis. A simple 'single protocol' improved doctors' thromboprophylaxis compliance on replicate audit. The randomised trial assessing the 'single protocol' showed no postoperative DVT occurred in the low or moderate-risk patients (n=85). Twenty-one DVT occurred in nineteen patients, all were high-risk patients (n=291): two with Thrombexin® Climax™ thigh-length stockings and eleven with Thrombexin® Climax™ kneelength (p
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available