Evaluation of the risk of venous thromboembolism and the appropriateness of thromboprophylaxis in general surgery patients

Venous thromboembolism (VTE) is the primary cause of death after surgery. The risks of VTE in surgical patients are well defined. Despite this, primary thromboprophylaxis can be neglected in surgical patients. The aim of this study was to evaluate the risk of VTE and the appropriateness of thromboprophylaxis in general surgery patients and to assess the effects of education and clinical pharmacy practices. This study was carried out between March 1st and December 10th, 2021 in Hacettepe University Hospitals Department of General Surgery in a total of 3 periods: pre-education (n=340), post-education (n=269) and clinical pharmacist intervention period (n=191). The risk of VTE and the appropriateness of prophylaxis of patients who underwent surgery in the pre-education period was evaluated. At the end of the pre-education period, education was given about the guidelines on thromboprophylaxis and an educative poster was posted in the services. The risk of VTE and the appropriateness of prophylaxis of patients who underwent surgery in the post-education period was re-evaluated. During the clinical pharmacist recommended period, the clinical pharmacist made recommendations to the responsible physicians of patients who did not receive optimal TP, included in the information content, and the appropriateness of VTE risk and prophylaxis was reassessed. In our study, while there was no significant difference in the optimal TP rate applied to the patients before and after the information period (40.6% vs. 45.4%; p=0.238); this rate was increased to 59.2% in the clinical pharmacist intervention period (p=0.004). High-risk patients who received one type of thromboprophylaxis constituted the majority of patients who did not receive optimal TP. While the ratio of high-risk patients who underwent a single type of thromboprophylaxis in the pre- and post-education period (30.6% vs. 30.9%), was similar (p=0.819); with the clinical pharmacist interventions, this rate was reduced to 18.3% (p=0.001). The implementation of clinical pharmacy practices into general surgery services is important especially in terms of maintaining optimal TP. Keywords: Venous thromboembolism, prophylaxis, thromboprophylaxis, clinical pharmacist, general surgery