Precautions to be taken in patient prior to surgery in DVT patients?

Answer 1

This will give you an insight view:
The aims of treatment are:

* To prevent the clot spreading up the vein and getting larger. This prevents the possibility of a large embolus breaking off and travelling to the lungs.
* To reduce the risk of post-thrombotic syndrome developing.
* To prevent a further DVT in the future.

Anticoagulation - preventing the clot from getting larger
Anticoagulation is often called 'thinning the blood'. However, it does not actually thin the blood. It alters certain chemicals in the blood to stop clots forming so easily. This prevents a DVT from getting larger, and prevents any new clots from forming. Warfarin is the usual anticoagulant. However, it takes a few days for warfarin tablets to work fully. Therefore, heparin injections are often used in the first few days for immediate effect. A serious embolus is rare if you start anticoagulation treatment early after a DVT.

The aim is to get the dose of warfarin just right so the blood will not clot easily, but not too much which may cause bleeding problems. You will need regular blood tests whilst you take warfarin. You need them quite often at first, but then less frequently once the correct dose is found. (If you are pregnant, regular heparin injections rather than warfarin tablets may be used.)

The length of time you will be advised to take anticoagulation for depends on various factors. For example, if you have a DVT during pregnancy or after an operation, then after the birth or when you are fit again the increased risk is much reduced and so the anticoagulation may be only for a few months. On the other hand, some people continue to have an increased risk of having a DVT in which case the anticoagulation may be long-term. Your doctor will advise.

Compression and raising the leg - to help prevent post-thrombotic syndrome
If the DVT was in a thigh vein, you may be advised to wear a compression stocking. This treatment reduces the risk of developing post-thrombotic syndrome. You should wear the stocking each day, for at least two years. (Symptoms of post-thrombotic syndrome may develop even several months or years after having a DVT, which is why you should wear the stocking long-term.)

Note: a compression stocking used following a DVT should be fitted professionally after an assessment and accurate measurement. Do not just buy 'over the counter' support stockings that may be the wrong class or size which may potentially cause more damage.

If you are advised to wear a compression stocking, you should put it on each day whilst lying in bed before getting up. Wear it for the whole day until you go to bed, or until you rest in the evening with the leg raised. Take the stocking off before going to bed. The slight pressure from the stocking helps to prevent fluid seeping into the calf tissues from the outer veins which carry the extra diverted blood following a DVT. The stocking also reduces, and may prevent, calf swelling. This in turn reduces discomfort and the risk of skin ulcers forming.

In addition, you may also be advised to do the following.

* Raise your leg when you are resting. This too reduces the pressure in the calf veins, and helps to prevent blood and fluid from 'pooling' in the calves. 'Raised' means that your foot is higher than your hip so gravity helps with blood flow returning from the calf. The easiest way to raise your leg is to recline on a sofa with your leg up on a cushion.
* Raise the foot of the bed a few inches if it is comfortable to sleep like this. This is so your foot and calf are slightly higher than your hip when you are asleep.

Preventing a first DVT - or a recurrence of a DVT
A DVT is often a 'one-off' event after a major operation. However, some people have an ongoing risk of a further DVT. For example, if you have a blood clotting problem, or continued immobility. As mentioned above, you may be advised to take anticoagulation (usually with warfarin) long-term.

Other things that may help to prevent a first or recurrent DVT include the following.

* If possible, avoid long periods of immobility such as sitting in a chair for many hours. If you are able, get up and walk around now and then. A daily brisk walk for 30-60 minutes is even better if you can do this. The aim is to stop the blood 'pooling', and to get the circulation in the legs moving. Regular exercise of the calf muscles also helps. You can do some calf exercises even when you are sitting.
* Major surgical operations are known to be a risk for a DVT - particularly operations to the hip, lower abdomen, and leg. You may be given an anticoagulant such as a heparin injection just before having an operation to help prevent a DVT. An inflatable sleeve connected to a pump to compress the legs during a long operation may also be used. It is also common practice to get you up and walking as soon as possible after an operation.
* When you travel on long plane journeys, train journeys, etc, you should have little walks up and down the aisle every now and then. Also, exercise your calf muscles every now and then whilst sitting in your seat. A separate leaflet called 'Preventing DVT When You Travel' gives more details.

Other treatments

Sometimes other treatments may be considered. For example:

* Thrombolytic therapy (often called 'clot busting') with drugs such as streptokinase or urokinase. These drugs may help to 'dissolve' a blood clot. This is not routine treatment as it is not clear how effective it is. However, it is sometimes used in people with a severe DVT or with a large pulmonary embolus.
* Sometimes an operation is done to remove a blood clot from the leg vein or pulmonary artery. These operations are not routine and it is not clear if they are an effective treatment in most cases.
* Occasionally, an operation is done to place a 'filter' in the large vein above the blocked leg vein. The aim is to stop any blood clots from traveling up to the lungs. This may be considered if anticoagulation cannot be given (for various reasons) or if anticoagulation fails to prevent clots breaking off and traveling up into the larger veins and up to the lungs.

In summary

* The main cause of DVT is immobility - especially during surgery.
* The most serious complication of DVT is a pulmonary embolus where part of the blood clot breaks off and travels to the lung.
* Persistent calf symptoms may occur after a DVT.
* With treatment, the risk of the above two complications is much reduced.
* Treatment includes anticoagulation, compression stockings, leg elevation, and keeping active.
* Prevention is important if you have an increased risk of DVT. For example, during long operations or when you travel on long journeys.

Answer 2

For minor surgery/day surgery probably TED stockings adequate pre op and post op, occassionally a anti coagulant on morning of surgery, perform ankle and leg exercises, prompt mobility.For longer operations, especially where mobiltity going to be impaired, as well as the above procedures, 28 -48hrs prior to surgery may commence on anti coagulant, usually injection and will continue till patient mobile. Blood testing pre / post surgery done to check clotting times.Generalisation only as each operation different protocols and also Consultant preferences.

Answer 3

Doctors may prescribe anticoagulants to help prevent DVT in high-risk people or those who are undergoing high-risk surgery. To help prevent DVT, move your legs often during long plane trips, car trips, and other situations in which you are sitting or lying down for long periods of time