Guidelines in place to prevent deadly blood clots not always sufficient
According to recent study results, potentially lethal blood clots still develop in patients within the first month following colorectal surgery despite the use of clot-prevention treatments. These clots form in patients especially if a surgical-site infection developed while in the hospital, according to results of the study at Johns Hopkins.
Study leader Susan L. Gearhart, MD, an associate professor of surgery at the Johns Hopkins University School of Medicine, and colleagues found that patients who developed a surgical-site infection after abdominal surgery were 4 times more likely to acquire a deep-vein thrombosis (DVT) in the legs or a pulmonary embolism (PE) in the lungs compared with infection-free patients.
Only 4% of study patients developed a DVT. However, 92% of those who acquired a DVT had received prophylaxis, which has been shown in previous research to be the best practice for DVT prevention.
This study also shows that venous thromboembolisms (VTEs) still occur, even when hospitals observe prevention guidelines. “We need heightened awareness about the potential for venous thromboembolism in patients with surgical-site infections,” says Gearhart. “We need to think beyond the prophylaxis we are already giving these patients. We need to think smarter.”
For their study, published in the Journal of the American College of Surgeons, Gearhart and colleagues reviewed the records of 615 adults who underwent colorectal surgery at The Johns Hopkins Hospital between July 2009 and July 2011. VTE developed in 25 patients (4.1%). Among those who acquired a VTE, 92% had received VTE prophylaxis.
Furthermore, 14 of the 25 patients with VTE (56%) also developed postoperative infections. Only 28.5% (168) of patients without VTE developed infections. Study results showed the infectious complications occurred prior to or on the same day as the VTE in 9 of the 14 patients (64.3%).
Gearhart says more intense monitoring of colorectal surgery patients who develop surgical-site infections may be required. Frequent ultrasound screening for clots in those with infections should be a consideration. She also suggests that, regardless of discharge date, these patients continue to take blood thinners for 30 days after surgery.
Source: Johns Hopkins Medicine.