Article type
Year
Abstract
Background: Implementation of scientific evidence in clinical practice has always been a long process. Patients undergoing major surgery risk postoperative thromboembolic complications: deep venous thrombosis (DVT) and pulmonary embolism (PE). Around 1975 evidence was established that small doses of unfractionated heparin reduce the incidence of fatal PE. Later around 1990 the same was shown for low molecular weight heparin (LMWH), a drug easier to administer to patients. The efficacy of TED-stockings in the prevention of DVT was finally established around 1985. General guidelines for thromboprophylaxis (TP) from the Danish Society of Thrombosis and Haemostasis were published in 1998.
Objectives: To assess the guidelines and attitudes in Danish surgical wards to the use of perioperative thromboprophylaxis.
Methods: Questionnaires regarding thromboprophylaxis have been sent every fifth year from 1981-2005 to all wards performing major surgery.
Results: During the six surveys, 85%, 90%, 92%, 95%, 93% and 87% of the approximately 200 wards answered the questionnaire, respectively. For overall results see Figure. Two-thirds of the 11% of the wards that did not use TP following guidelines did use them on selected patients, the remaining one-third that did not use TP were day-wards. In acute surgery we found a significant increase in the number of wards using TP following clinical guidelines, from 43% in 2000 to 79% in 2005 (p<0.00005 Fisher's exact test). All the wards that used TP used LMWH; more than half (56%) used it in conjunction with TED-stockings.
Conclusions: Thirty years after the first evidence was published, the number of surgical wards using TP routinely based on clinical guidelines hovers around 90%. And finally a greater number of wards performing acute surgery follows suit. Steps should be taken now and in the future to ensure that firm evidence when available will be implemented faster, 25 to 30 years is too long to wait for the proper treatment.
Objectives: To assess the guidelines and attitudes in Danish surgical wards to the use of perioperative thromboprophylaxis.
Methods: Questionnaires regarding thromboprophylaxis have been sent every fifth year from 1981-2005 to all wards performing major surgery.
Results: During the six surveys, 85%, 90%, 92%, 95%, 93% and 87% of the approximately 200 wards answered the questionnaire, respectively. For overall results see Figure. Two-thirds of the 11% of the wards that did not use TP following guidelines did use them on selected patients, the remaining one-third that did not use TP were day-wards. In acute surgery we found a significant increase in the number of wards using TP following clinical guidelines, from 43% in 2000 to 79% in 2005 (p<0.00005 Fisher's exact test). All the wards that used TP used LMWH; more than half (56%) used it in conjunction with TED-stockings.
Conclusions: Thirty years after the first evidence was published, the number of surgical wards using TP routinely based on clinical guidelines hovers around 90%. And finally a greater number of wards performing acute surgery follows suit. Steps should be taken now and in the future to ensure that firm evidence when available will be implemented faster, 25 to 30 years is too long to wait for the proper treatment.