Having An Op Done? Know Your Risk Of Clotting

If you have an upcoming surgery scheduled, it is common to feel anxious or scared.

Tomophobia, the fear of medical procedures, is reported to be experienced by up to 92% of the world’s population, which comes as no surprise as undergoing an invasive medical procedure can be daunting for even the bravest individual. But do we really need to fear undergoing an op? The answer is no.

Preoperative stress can actually have a negative effect on postoperative recovery, resulting in heightened pain, longer recovery periods, and prolonged bed rest, all of which increase your risk of developing thrombosis.

To help lessen your fears it is recommended that you inform yourself of any risks associated with a procedure and talk to your doctor about the procedure. One very real risk that all hospitalised patients – especially those facing prolonged immobility – should be aware of is Venous Thromboembolism (VTE), also known as blood clots. It is a startling fact that up to 60% of all VTE cases occur during or within 90 days of hospitalisation, making it a leading cause of death and disability.

What are the risk factors?

While there are many factors that can contribute to the development of thrombosis, being in the hospital is a major risk factor. This is because patients with decreased mobility due to bed rest or recovery, or who experience blood vessel trauma due to surgery or other serious injuries, are more likely to develop blood clots.

Your medical history and lifestyle habits also play a big role in an increased VTE risk, as do certain medical procedures, such as orthopedic, urological, and cardiothoracic surgeries. Major peripheral vascular, gynecological, and general surgery – especially involving the abdomen, pelvis, hips, or legs, neurosurgery, and, in fact, any surgical procedure with a duration of more than 45 minutes also bear an increased risk.

The good news is that VTEs are often preventable and evidence-based prevention strategies can stop the development of clots in ‘at-risk’ individuals. According to the Centers for Disease Control and Prevention (CDC), as many as 70% of cases of VTEs are preventable through measures such as the use of blood thinning medications called anticoagulants, which help prevent blood from clotting. Yet, states the CDC, fewer than half of hospital patients receive these measures.

If you, or a loved one, are due to undergo any of the above procedures, you should definitely adopt a proactive approach and ask your doctor for a VTE Risk Assessment before the operation, and whether you are a candidate for anticoagulants.  A VTE Risk assessment is a questionnaire that gathers information about your age, medical history, medications, and specific lifestyle factors, which is then used to discern your potential risk for blood clotting.

What other questions should I ask?

All patients are encouraged to ask their healthcare practitioners as many questions as possible about the procedure, risk factors, aftercare, and recovery, in order to allay any fears they may have. Regarding VTEs, here are some questions that are recommended  to ask:

• What is my risk of developing a blood clot?

• Please conduct a VTE risk assessment.

• What can be done to lower my risk?

• Will I be given some type of blood clot prevention while at the hospital, and when I leave?

• What are the warning signs or symptoms of a blood clot?

• What should I do if I develop any warning signs or symptoms?

What can be done if I am at risk?

Individuals who are deemed ‘at-risk’ should be given appropriate prevention, referred to as “prophylaxis”, which can include anticoagulants and mechanical devices (compression stockings, intermittent pneumatic compression devices or rapid inflation venous foot pumps). Your doctors will also assess your bleeding risk to know if you are fit for pharmacological prophylaxis anti-clotting medications, otherwise, you will be placed on a mechanical device.

Hospital patients may also be instructed to move around or do foot and leg exercises as soon and as often as possible.

In line with World Patient Safety Day on Saturday 17 September – which calls for global solidarity and concerted action by all countries and international partners to improve patient safety – the WTD Day campaign advises that “every hospital worldwide should establish and enforce a VTE protocol. Protocols may vary by institution and country but should include a VTE risk assessment that is tied to proper prevention and treatment guidelines.”

Dr Helen Okoye, Medical expert and Spokesperson, World Thrombosis Day (WTD) campaign.