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Our knowledge of postoperative thromboembolic complications has increased enormously over the past 2 decades, particularly where diag nosis and prophylaxis are concerned. The 125 I-fibrinogen method of diagnosing thrombosis has completely changed our concept of the frequency, occurrence, and natural course of thrombosis, and it has formed the basis of most thromboprophylactic studies. Concurrently with the development of this diagnostic method, two methods for the prophylaxis of thrombosis have come into vo gue, namely low-dose heparin and dextran. Both these methods were tested in very extensive studies during the seventies, and their value has been unequivocally proved, for reducing both the frequency of thrombosis with and without symptoms, and the frequency of fatal pulmonary embolism. Thromboprophylaxis is not particularly common in surgery; how ever, and its general use is far from uncontested. It has been argued that not only does it complicate surgical activities and make them mo re expensive, but it also involves an unacceptable number of other complications.
List of contents
Definitions.- History.- Frequency of Thromboembolic Complications.- Diagnosis of Deep Vein Thrombosis.- Diagnosis of Pulmonary Embolism.- Incidence of Thrombosis.- Incidence of Pulmonary Embolism.- Incidence of Post-thrombotic Venous Insufficiency.- Time of Onset of Thromboembolism.- Summary.- Pathogenesis of Thrombosis.- Changes of the Vessel Wall.- Changes in the Blood Flow.- Changes of Blood Properties.- Postoperative Thrombosis. The Pathogenetic Hypothesis...- Summary.- Risk Factors.- Importance of the Type of Anesthesia.- Geographic Factors.- Seasonal Variation.- Other Factors.- Risk Factor Assessment.- Summary.- Prophylaxis of Thromboembolism.- Mechanical Methods.- Oral Anticoagulants.- Ancrod.- Low-Dose Heparin.- Heparin Analogues.- Dihydroergotamine and a Combination of Dihydroergotamine and Low-Dose Heparin.- Platelet-Influencing Agents.- Dextran.- Comparative Studies of Low-Dose Heparin and Dextran.- Other Prophylactic Methods.- Combination Prophylaxis.- Use of Prophylaxis.- Prophylaxis Against Thromboembolism in Various Clinical Situations.- References.- Books and Reviews Dealing with Thromboprophylactic Problems.- Subject Index..
Summary
Our knowledge of postoperative thromboembolic complications has increased enormously over the past 2 decades, particularly where diag nosis and prophylaxis are concerned. The 125 I-fibrinogen method of diagnosing thrombosis has completely changed our concept of the frequency, occurrence, and natural course of thrombosis, and it has formed the basis of most thromboprophylactic studies. Concurrently with the development of this diagnostic method, two methods for the prophylaxis of thrombosis have come into vo gue, namely low-dose heparin and dextran. Both these methods were tested in very extensive studies during the seventies, and their value has been unequivocally proved, for reducing both the frequency of thrombosis with and without symptoms, and the frequency of fatal pulmonary embolism. Thromboprophylaxis is not particularly common in surgery; how ever, and its general use is far from uncontested. It has been argued that not only does it complicate surgical activities and make them mo re expensive, but it also involves an unacceptable number of other complications.
