Note
General information on the topic of thrombosis prophylaxis can be found on the homepage on the topic: Thrombosis prophylaxis
Start of prophylaxis
The start of thrombosis prophylaxis should be as early as possible to the risk-causing situation. Nowadays, thrombosis prophylaxis is routinely performed in inpatient surgical departments both peri- and postoperatively, usually until discharge. If there is a need for relief (e.g. a hip prosthesis), prophylaxis must be given even after discharge.
Duration of thrombosis prophylaxis
The duration of prophylaxis depends on the persistence of the risk factors. There are currently no fixed rules as to exactly how long a thrombosis prophylaxis should be carried out. Several studies on the topic of thrombosis prophylaxis provide initial information for different risk profiles.
For example, patients should receive post-operative drug-based thrombosis prophylaxis for about 4 – 5 weeks. According to the guidelines of the German Society of Surgery 2003, the duration of prophylaxis after surgery should be determined by the additional dispositional risk factors, the surgical trauma and the degree of immobilization. For outpatient surgical procedures, thrombosis prophylaxis is recommended for the duration of immobilization of the operated extremity.
- With hip prosthesis
- After hip fracturesFemoral neck fracture or
- After surgery of a malignant tumor
Special feature of surgery
In operations with anaesthesia procedures close to the spinal cord, the prophylaxis of thrombosis with medication may only be carried out after the catheter has been removed at a safe interval. For some operations (e.g. in the head and neck region), drug prophylaxis is not recommended, provided that no additional risk factors are present.
Classification
In thrombosis prophylaxis, a distinction is made between physical and medicinal measures. The physical measures include : In drug intervention, a number of different drugs are available to reduce the blood‘s tendency to clot. The points of attack are the different components of the coagulation system.
The differentiated use and dosage of the drugs depend on the risk profile of the person affected.
- Mobilization
- Storage
- Brushing out the veins
- Vein Compressions
- Promotion of the return flow through gymnastics
In order to better understand the various measures of thrombosis prophylaxis, it is helpful to know some basic facts about blood coagulation. The following are essentially responsible for blood coagulation Blood coagulation (also known as hemostasis) is divided into primary and secondary hemostasis.
In addition, the speed of blood flow, the composition or toughness of the blood and the willingness to clot are of crucial importance (Virchow Triad). The coagulation factors IX, X, VII and II are dependent on vitamin K in their function. Primary and secondary hemostasis as well as endogenous and exogenous pathways do not occur alone or sequentially, but rather in parallel.
- The nucleusless blood platelets (thrombocytes)
- The coagulation factors
- As well as some other factors
All articles in this series:
