| April 2006 · Vol. 18, No. 4 SURGICAL TECHNIQUE
Preventing VTE: Evidence-based perioperative tactics
The perfect strategy has yet to be devised, but good data point to drug and mechanical methods that come close
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Fast Track
2 prophylactic strategies
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Low-dose heparin, 5,000 U, starting 2 hours before surgery and every 8–12 hours afterward until hospital discharge
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Low-molecular-weight heparin, 3,400 U per day until discharge
Postop VTE declines 3-fold with external pneumatic compression during surgery and for 5 days postop
80% of symptomatic pulmonary emboli show no signs or symptoms of thrombosis in the lower extremities
Classic pulmonary embolism
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Pleuritic chest pain
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Hemoptysis
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Shortness of breath
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Tachycardia
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Tachypnea
Interventions for pulmonary embolism
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Daniel
L.
Clarke-Pearson,
MDRobert A. Ross Professor and Chair, Department of Obstetrics and Gynecology, University of North Carolina,
Chapel Hill, NC
Pulmonary embolism is a master of disguises. It can appear with classic symptoms such as pleuritic chest pain, hemoptysis, and tachycardia—or it can arrive more insidiously, apparent only as a slight elevation in the respiratory rate.
This matters because 40% of all deaths following gynecologic surgery are directly attributable to pulmonary emboli,1 and pulmonary emboli are the most frequent cause of postoperative death in women with uterine or cervical carcinoma.2
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