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(Circulation. 2007;115:e302-e307.)
© 2007 American Heart Association, Inc.

Clinician Update

Prevention of Pulmonary Embolism in General Surgery Patients

Urszula Zurawska, BS; Sudha Parasuraman, MD; Samuel Z. Goldhaber, MD

From the University of Western Ontario, London, Ontario, Canada (U.Z.), and Cardiovascular Division, Brigham and Women’s Hospital (S.P., S.Z.G.) and Hematology/Oncology Division, Children’s Hospital (S.P.), Harvard Medical School, Boston, Mass.

Correspondence to Samuel Z. Goldhaber, MD, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail sgoldhaber@partners.org

Key Words: anticoagulants • embolism • heparin • prophylaxis • risk factors • surgery • thrombosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Case Presentation: A 29-year-old woman presented to the emergency department with complaints of pleuritic chest pain, fever, and left ankle swelling and tenderness. Cardiac examination was normal except for tachycardia. A chest computed tomography scan with contrast demonstrated extensive bilateral pulmonary emboli. Thirteen days previously, an intoxicated driver with multiple prior convictions for driving under the influence of alcohol crashed head-on into her car at a high speed. She was 8 months’ pregnant and suffered the loss of the child. She spent 7 days in the hospital and underwent cesarean section, exploratory laparotomy, and splenectomy. No preoperative pharmacological prophylaxis against venous thromboembolism (VTE) was administered.

	Epidemiology

 
VTE, which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important and common complication of general surgery.

A new era in the postoperative management of surgical patients began in 1975 when the effectiveness of low-dose heparin in preventing postoperative DVT and PE was established by the pivotal International Multicenter Trial.¹ The dose was 5000 U subcutaneously every 8 hours, with the first injection administered 2 hours before the skin incision. Compared with control, the incidence of DVT in patients receiving heparin decreased from 24.6% to 7.7%. Similarly, the incidence of autopsy-proven PE was reduced 8-fold. The results of this trial introduced and validated the concept of using low-dose heparin to prevent postoperative VTE. This trial revolutionized surgical practice. By 1994, 90% of North American general surgeons reported the routine use of thromboprophylaxis.²

	Natural History

 
Most postoperative DVT originates in the deep calf veins, . . . [Full Text of this Article]

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Circulation 2007 115: 1059. [Extract] [Full Text]

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