Formation of blood clots after surgery: causes. Postoperative thrombosis

Inflammation of the walls of blood vessels and the formation of a blood clot in the lumen is called. A thrombus that has broken away from the wall of a vessel and moves further with the blood flow is called an embolus. Its penetration into the pulmonary artery will cause thromboembolism, blockage of the lumen of the vessel with a blood clot, a dangerous postoperative complication.

To avoid possible consequences, you must carefully follow preventive measures.

Predisposing factors

The process of blood clot formation refers to the protective functions of the body. During surgical intervention the integrity of tissues and all kinds of blood vessels (capillaries, veins) is compromised. Turn on defense mechanisms body and small blood clots appear that close the damage.

An important factor in the formation of blood clots is prolonged immobility of the patient. In this case, normal blood circulation is disrupted and venous blood flow slows down. Most often, this situation occurs during operations on the lower extremities followed by the application of a plaster cast.

In addition, a number of factors are necessary, the presence of which increases the risk of developing blood clots:

• High blood clotting.
• Age exceeding 40 years of age.
• Prolonged immobility of the patient caused by paralysis, compound fracture or other reason.
• Obesity.
• Diabetes.
• Malignant neoplasms.
• Pathological processes of the cardiovascular system. Heart attacks, ischemia, cardiovascular, and others.
• Inflammatory bowel diseases.
• Long-term use of estrogen.
• Large surgical operations, long surgical time.
• Fractures of the pelvic bones, lower limbs.

In the presence of factors that increase the risk of blood clots, the natural protective process fails and the resulting blood clot not only closes the damaged area in the vessel, but can completely block the lumen of a vein or artery.

What surgeries increase the risk of blood clots?

Patients are usually divided into three main risk groups:

1. Minimum risk group. This includes patients without a history of paralysis, taking hormonal drugs or other provoking factors. And the planned surgical intervention will not take much time. The probability of developing thrombosis after surgery in this group does not exceed 10%.
2. Medium risk group. This group includes patients over 40 years of age who are undergoing extensive or long-term surgical intervention. However, it is necessary complete absence risk factors. The development of vascular thrombosis is slightly higher, approximately 20-40%.
3. Group high risk. This includes patients who have several precipitating factors. The risk of developing complications in the form of thromboembolism is the highest – up to 80%.

The type of surgery performed also affects the development of blood clots. The greatest danger in this case is surgical manipulations for varicose veins, amputation of limbs, malignant neoplasms, surgical treatment of injuries and fractures of the lower extremities.

For example, during abdominal surgery, after which patients have difficulty but can move, the risk of developing blood clots does not exceed 35%. At the same time, after hip or knee replacement, the risk increases to 70%. In this case, the patient is practically unable to move, stand up or walk. As a result, venous blood flow slows down and the likelihood of developing blood clots increases.

Symptoms

The manifestation of clinical symptoms will depend on which veins have undergone pathological processes. The most common occurrence is thrombosis of the veins of the lower extremities. In approximately 70-80% of all cases, thrombophlebitis of the right leg is observed.

If thrombophlebitis occurs in superficial veins, the symptoms will be mild. For blockage of deep veins clinical manifestations will arise quickly (acutely), and external changes will be pronounced.

Initially, there is slight swelling and tenderness of the affected limb. Subsequently, an increase in swelling is noted. Color changes skin: above the site of blockage of the vessel, the skin becomes red, and below it acquires a bluish tint. The affected vessel looks like a dense cord of a specific purple color. The pain syndrome gradually increases.

Signs of intoxication of the body appear: nausea, fever, chills, weakness, lethargy, sweating and rapid heartbeat.

This situation threatens the formation of tissue necrosis, blood clot separation and the formation of thromboembolism.

Which doctor treats thrombosis after surgery?

Until recently, pathologies of the circulatory system were dealt with by surgeons and cardiologists. But progress does not stand still. IN medical practice appeared separate structure– phlebology, the main function of which is the treatment of pathologies associated with blood vessels. Accordingly, a phlebologist will become a specialist treating thrombosis after surgery.

Treatment

Medical tactics will depend on the complexity of the process.

Medication assistance

Therapy will be aimed at resolving the blood clot, followed by normalization of blood circulation:

• Drugs for resorption of blood clots: Streptokinase, Urokinase, Alteplase, Tenecteplase.
• Blood thinners that prevent the formation of new clots: Heparin, Curantil, Aspirin and others.
• Anti-inflammatory tablets: Ibuprofen, Ketofen. According to indications, antibiotics may be used.
• In order to relieve spasms and reduce pain, Spazmolgon and No-Shpu are used.
• Use intravenous drip administration of saline, glucose, ascorbic acid. This helps thin the blood.
• Bed rest and the use of special underwear (compression) are mandatory.

In cases where treatment does not bring results or a very deep process is observed, surgical treatment is performed.

Surgical assistance

For thrombophlebitis of the lower extremities, the following manipulations are performed:

• Thrombectomy – surgical removal of a blood clot from a vessel.
• Endovascular surgery – removal of blood clots by inserting a special catheter and probe into the vessel.
• Radio wave operation – destruction of blood clots by radio waves; a catheter with a radio wave head is inserted into the lumen of the vessel.

The choice of surgical intervention depends on the severity of the pathological process and the patient’s condition. The decision is made by the doctor, but the patient's opinion also matters.

Prevention

Basic measures to prevent blood clots after surgery:

• Minimize the time the patient is immobile. Very often, patients are forced to sit or walk around the ward already on the first day after surgery. This measure is aimed at restoring normal blood flow, including venous.
• Physiotherapy. A feasible physical activity is prescribed: bending the foot, lifting the leg, and so on. Even such minimal work of ligaments, muscles and tendons helps prevent venous stagnation.
• Wearing.
• Use of medications. Prodaxa, Eliquis and others tablets are prescribed. The course of application is from two to five weeks.

Thrombophlebitis after surgery is a serious pathology, health threatening and human life. Ignoring the symptoms of venous thrombosis can lead to the development of pulmonary thromboembolism and death.

In the process of preparing for surgery, the patient can help minimize the risk of developing venous thrombosis. To do this, you need to give up bad habits, rationalize your diet, and reduce excess weight. Before carrying out a planned intervention, it would be useful to examine for the presence of varicose veins.

Useful video about blood clots

It is believed that about 70% of humanity is potentially at risk of thrombosis. Since the threat to health is becoming so widespread, the issues of preventing this condition become relevant. How can you avoid getting into the risk zone and avoid the problems associated with it? How to alleviate your condition if you are already at risk? Why are thromboses so dangerous? These and some other questions need to be answered as soon as possible.

In the article we will consider step by step instructions preventive measures for various types thrombosis

What is thrombosis?

To understand how important the prevention of thrombosis is, you need to understand what kind of disease it is. Thrombosis is a condition in which the blood flow in the vascular beds is gradually blocked. Blood clots (thrombi) become an obstacle to the normal movement of blood, which complicates the functioning of organs and systems. Thrombosis can cause heart attacks, strokes, and obstruction of peripheral veins and arteries. This pathology can seriously undermine the health or shorten the patient’s life.

Mechanism of thrombus formation

When blood vessels are damaged, dense clots (thrombi) prevent dangerous blood loss. They are formed mainly from platelets and fibrin, but depending on the type of thrombus, leukocytes and red blood cells may be present in it.

Thrombosis begins with platelet adhesion. This means that platelets begin to adhere to the inner surface of the vessel at the site of damage. Then the process of agglutination begins, that is, the gluing of individual platelets into a dense clot. Thus, the protective process of blood clotting is launched.

Virchow's triad

Back in the 20th century, the famous German physician R. Virchow noticed a certain pathology, which was later given the name “Virchow’s Triad.” He found that the formation of a blood clot in the venous lumen is influenced by 3 factors:

• change in the speed (slowdown) of blood flow;
• increased coagulation (thickening) of blood;
• violation of the integrity of the internal endothelium of the vascular walls.

Factors causing the appearance thrombosis may occur due to various reasons. Sometimes these are genetic defects or autoimmune diseases. Sometimes - injuries, infections, surgical procedures, blood stagnation, and so on.

Deep vein thrombosis. Prevention measures

Prevention of deep vein thrombosis is a set of simple measures that can save a person’s life. This type of thrombosis most often affects veins in the thigh, leg or pelvis. We can talk about large clots that can break off and move through the blood vessels. Such blood clots are called embolic; their main danger is movement into pulmonary vessels, where they cause arterial thromboembolism. A large clot can cause death.

Prevention of deep vein thrombosis is most important for elderly people, for immobile patients (after injuries or complex operations), for women in labor and pregnant women, for obese people, smokers and women protecting themselves from pregnancy with oral contraceptives.

As a preventive measure, patients are prescribed anticoagulants and wearing compression stockings.

Risk of deep vein thrombosis during flights

Prevention of thrombosis of the lower extremities is especially important for people who are forced to take long flights, car or bus trips. Prolonged immobility provokes blood stagnation. If a person does not have the opportunity to stretch his legs for more than four hours, the risk of blood clots increases significantly. If on a bus or in a car there is an opportunity to stop and warm up, then on an airplane there is often simply no such opportunity. The most unpleasant thing is that the health hazard persists for about 4 weeks after prolonged forced immobility.

Prevention of vascular thrombosis in this case involves the use of compression stockings or knee socks. On the recommendation of a doctor, you can get a heparin injection before a long flight. Taking aspirin will also reduce the risk of blood clots, but its effectiveness is noticeably less.

How to protect yourself during a flight

The following tips can be useful, even for completely healthy people. There is nothing complicated in these recommendations. Such prevention of thrombosis during long flights will help reduce the risk of the disease. Airline passengers must follow simple rules:

1. Avoid drinking too much alcohol, it causes dehydration by increasing the thickness of your blood. Also give up tea and coffee. Are you thirsty? Take still water, you can drink it without fear.
2. Avoid smoking before and during your flight. Nicotine impairs blood flow and thickens the blood.
3. Get rid of the habit of crossing your legs. Do not create additional pressure on the veins so as not to cause stagnation in the vessels of the legs and pelvis.
4. Don't miss the opportunity to get up and move around. If you can't get up, then stretch and move your legs while sitting.
5. Dress loosely and comfortably. Buy compression hosiery for travel, which will improve venous outflow.

Postoperative thrombosis. Prevention

Despite the fact that blood clotting is the body's main way of protecting itself from blood loss due to injury, the mechanism of this system is often disrupted. We have already said that the reasons for such a failure can be very different. Now let's talk about one of the most dangerous conditions - postoperative thrombosis.

Prevention of postoperative thrombosis is important for every surgical patient. General anesthesia completely relaxes the muscles, at the same time the body automatically releases large portions of coagulating substances to stop bleeding. In addition to this, the patient remains motionless for some time horizontal position. As a result, coagulants thicken the blood, forming danger zones in the veins. In this case, the lower extremities are exposed to the maximum risk of thrombosis; the possibility of flotation with entry into the pulmonary circulation and blockage of the pulmonary artery is taken into account.

Elderly patients are especially affected. With a positive outcome of the operation, the most common cause of death in them is thrombosis. Prevention and treatment for older people is a mandatory preoperative complex. It includes:

• preoperative administration of anticoagulants;
• minimum mechanical damage, including the introduction of droppers only into the veins of the arms to avoid injury to the walls of the vessels of the lower extremities;
• aseptic measures to avoid infections;
• postoperative administration of direct and indirect anticoagulants;
• early motor activity use compression garments and elevated state of the lower extremities.

Prevention of thrombosis and subsequent postoperative treatment carried out under the supervision of a phlebologist.

Intestinal thrombosis

A dangerous disease is mesenteric thrombosis or intestinal thrombosis. This is an acute pathology of the patency of intestinal vessels, which results in their thrombosis.
Since intestinal thrombosis leads to rapid necrosis of a section of the intestine, surgery is performed to remove the affected area. The risk of intestinal thrombosis is highest in patients with cardiovascular diseases, atherosclerosis, hypertension and rheumatism.

Preventive measures can only be selected by a doctor. Self-medication in case of risk of intestinal thrombosis is unacceptable. This will be a complex of drugs that reduce blood clotting.

Portal thrombosis

The largest portal vein is located in the liver area, collecting blood from internal organs and carrying it to the heart. Portal thrombosis is the blockage of this vein in the spleen or inside the liver. If portal venous thrombosis is suspected, prevention and treatment should be carried out by highly qualified specialists, since the mortality rate in this case is very high.

Preventive measures for portal thrombosis include taking anticoagulants, timely treatment underlying disease, lack of high physical activity and regular examinations by specialists.

Treatment of portal thrombosis is most often performed by bypassing the vena cava and portal veins to restore blood circulation.

Prevention of thrombosis is a priority for many patients proper diet, promoting blood thinning. The diet must include polyunsaturated fats and foods containing vitamins C and E. These include sea fish, sunflower and pumpkin seeds, unrefined sunflower oil, chestnuts, cereal grains, asparagus, and corn. Sprouted wheat, avocado, and legumes (peas, beans) are considered beneficial. This category also includes nuts, cabbage, bell peppers, apples, grapes, figs, cherries, dill and various berries. Having a sufficient amount of these products in your weekly diet is an excellent prevention of venous thrombosis.

But there are a number of foods that should not be consumed if there is a risk of thrombosis. These are smoked meats, sausages and frankfurters, scrambled eggs, fatty cheeses and dairy products, all types of dairy ice cream. In addition, you should not eat sweets and baked goods with margarine. You can't drink coffee or eat chocolate. Toffees, cakes with butter cream and egg whites. Mayonnaise and cream sauces are excluded from the diet. Reduce consumption or completely quit alcohol and nicotine. If these products are present in the diet, patients remain at risk of disease.

Lifestyle

Prevention of thrombosis cannot be based only on diet. It is very important to lead an active lifestyle and get enough physical activity. To avoid blood stagnation, you should walk daily, and sedentary workers should take breaks every 40 minutes for a short exercise, which can be replaced by brisk walking along the corridors. When performing physical exercises, you should always remember the danger of excessive overload. Activity should be in moderation.

Taking aspirin to prevent thrombosis

Drug protection against the risk of thrombosis includes anticoagulants, antiplatelet agents, as well as bioflavonoids, nicotinic acid, vitamins B6, B12, folic acid and vitamin E. However, many patients are confident that it is enough to take aspirin to prevent thrombosis, and everything else is not necessary. Daily intake of acetylsalicylic acid is indeed prescribed for prevention cardiovascular problems. But recent studies prove that the effectiveness of such a prescription is quite doubtful, since problems with gastrointestinal tract exceed the possible benefits. The latest studies were conducted in 2014 and involved almost 15 thousand patients. The effectiveness of aspirin in the control group was lower than the resulting side effects.

If, nevertheless, a decision is made to prescribe aspirin, then it should be taken in small dosages, strictly following the doctor’s recommendations.

Prevention of thrombosis: development risks, methods and means

In modern medicine, more and more attention is being paid to the prevention of thrombosis. This problem is relevant for doctors of all profiles and even more so for patients who care about their health. If thrombosis of the deep veins of the lower extremities, saphenous veins or veins of the surgical field itself rarely poses a real threat to life, then their immediate complication, pulmonary embolism, is a formidable condition that directly threatens human life.

thrombosis and life-threatening thromboembolism using the example of the veins of the lower extremities

In its development, any thrombosis is based on three main components: slowing blood flow, damage to the inner layer of vessel cells And increased susceptibility of blood to thrombus formation. Successful prevention of venous thrombosis requires an understanding of the importance of all three components.

1. Slow blood flow develops due to a number of reasons:

• Phlebeurysm;
• Physical obstruction to the outflow of blood - a tumor, a cyst, a bone fragment, an enlarged uterus, a focus of inflammation;
• Damage to venous valves;
• Forced sedentary or limited mobility of the body - plaster cast, strict bed rest, chronic cardiovascular failure;
• Blood thickening – erythrocytosis, dehydration, increased fibrinogen levels, polycythemia.

1. The main causes of damage to the endothelium (the inner layer of the venous vessel):

• Direct injury to the vein - intravascular injections, catheters, stents, vascular operations;
• Mechanical injury, especially accompanied by damage to the veins;
• Acute and chronic oxygen deficiency (hypoxia);
• Bacterial and viral infections, sepsis;
• Intoxication of various nature;
• Autoimmune diseases accompanied by the production of antibodies to components of the venous wall.

1. Increased tendency of blood to form blood clots called thrombophilia, it can be acquired (as a result of surgery, injury, pregnancy, childbirth) or congenital - caused by some defect in the blood coagulation system.

To prevent vascular thrombosis, a special scheme has been developed, which indicates in what conditions and by how much the risk of thrombosis increases. The intensity and appropriateness of prevention of thrombosis and thromboembolism are chosen based on this scheme:

1. The likelihood of thrombosis and embolism is increased by more than 10 times:

• Fractures of large leg bones;
• Atrial fibrillation or flutter;
• Acute heart failure and myocardial infarction;
• Installation of prosthetic knee and hip joints;
• Massive injury;
• Thrombosis in the past;
• Spinal cord injuries.

1. The chance of thrombosis is 2-9 times higher with following states:

• Endoscopy of the knee joint;
• Autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis);
• Condition after blood transfusion;
• Permanent central catheter - in the jugular, subclavian, femoral vein;
• The use of cytostatic drugs in treatment oncological diseases and oncological diseases themselves, especially those accompanied by metastasis;
• Chronic cardiovascular or respiratory failure;
• The use of drugs that increase the number of red blood cells (Eriprex, Recormon);
• Oral contraceptives;
• Condition after in vitro fertilization (IVF);
• Infectious diseases: pneumonia, nephritis, HIV infection, enterocolitis;
• Acute cerebrovascular accidents with paralysis (stroke, cerebral infarction);
• Postpartum period;
• Thrombophilia acquired or congenital.

1. Conditions in which the likelihood of thrombosis is increased by less than 2 times:

• Forced (lying) position for more than 3 days;
• Diabetes;
• High blood pressure;
• Prolonged sitting position (on an airplane, train, car);
• Minimally invasive (laparoscopic) operations;
• Obesity, especially in combination with a sedentary lifestyle;
• Pregnancy;
• Phlebeurysm.

Mainly based on the above elements, taking into account additional factors, the Caprini scale was developed, on the basis of which the risk of thrombosis is determined. There are very low, low, moderate and high risk. The use of drugs that reduce the likelihood of thrombosis inevitably increases the risk of bleeding and many other complications; on the basis of this scale, the justification for prescribing a particular drug is determined, so that the benefit always outweighs the risk.

Ways to prevent thrombosis

Globally, the prevention of deep vein thrombosis is based, regardless of any specifics, on just four main components:

Thrombosis and surgical interventions

Prevention of postoperative thrombosis is of particular importance, since after surgery of any profile, surgical, gynecological, neurosurgical, oncological and others, the risk of thrombosis and embolism increases significantly. In practice, when performing surgery, the following is used:

• Prophylactic administration of medications is carried out immediately before surgery (if there is no high risk of bleeding) or at as soon as possible after it, when hemostasis is reliably established (bleeding stops and its risk decreases significantly);
• Mechanical prevention ( compression stockings) is performed before, during and after surgery, until a sufficient level of physical activity is fully restored;
• Postoperative preventive actions, medicinal and physical are carried out depending on the volume of the operation and the established risk of thrombosis; in some cases, their duration can last up to 4 weeks after the intervention, regardless of the degree of physical activity.

Prevention means

Practical means of preventing thrombosis and embolism include various drugs And non-pharmacological means, which have a number of contraindications, interaction features and certain risks, which should be taken into account by a qualified doctor when choosing a method of prevention.

Basic medicines

Parenteral (not introduced into the body through the mouth) anticoagulants include 3 groups of drugs that are not interchangeable and have their own indications and contraindications:

1. Heparins (unfractionated and fractionated) act very quickly and effectively, but the use of these drugs has a high risk of bleeding, which determines the corresponding contraindications, as well as the need to actively look for signs of bleeding throughout the entire period of treatment. The use of drugs in this group must be carried out strictly according to the manufacturer's instructions and under constant monitoring of platelet levels and APTT (Activated partial thromboplastin time). The most common representatives: Heparin, Bemiparin sodium, Dalteparin sodium, Nadroparin calcium, Enoxaparin sodium.

Fondaparinux sodium (Arixtra) is a drug that rarely causes thrombocytopenia, but has the same high risk of bleeding and corresponding contraindications.

Oral (used “per oris” through the mouth) anticoagulants:

1. Vitamin K antagonists (Sintrom, Sinkumar, Warfarin, Warfin) are prescribed under the strict control of the hemostatic system - constant monitoring of the international normalized ratio (INR) is necessary, with preference given to Warfarin, other drugs are prescribed if it is not available. It should be noted that these drugs reach their peak effectiveness after some time, sometimes after a day or more, which does not allow their use in cases emergency prevention. A special stage in the prevention of thrombosis is the transition from Heparin injections to Warfarin tablets: their simultaneous use is mandatory for at least 5 days, and it is also necessary to carry out several laboratory controls of the state of the hemostatic system with an interval of at least 24 hours.

New oral anticoagulants (NOACs) are a group of drugs that have recently appeared in the arsenal of doctors:

1. Apixaban, Dabigatran etexilate and Rivaroxaban have a smaller range of contraindications and fewer cases of complications. They have become widespread in 3 main cases: orthopedic surgery (knee and hip joint replacement), early conservative treatment deep vein thrombosis in patients who have not received other treatment, as well as long-term prevention repeated thrombosis and embolism, when for some reason a vena cava filter was not installed. Drugs of this group quickly achieve their clinical effectiveness (1-2 hours), are quickly eliminated from the body and are easily interchangeable with drugs of the first group. The transition from vitamin K antagonists to NOACs is made gradually according to the scheme and under laboratory control of the hemostasis system.

The importance of Aspirin, despite the venerable age of this drug, in modern medicine is at the stage of confirming its effectiveness; the use of this drug once daily in a dosage of 100-150 mg per day is considered justified in the prevention of thrombosis.

Drugs of the dextran group (Polyglyukin, Reopoliglyukin, Poliglyusol), phlebotonics (Diosmin, Aescusan, Troxevasin, Antistax), as well as local drugs any content and form (ointment, cream, gel) are not a means of preventing and treating thrombosis and embolism, but only have a local effect, improving subjective sensations and local manifestations venous insufficiency.

Non-pharmacological means of preventing venous thrombosis:

• Compression stockings (or knee socks) come in 2 types: anti-embolic - always white, denser, they are used only for patients in a forced position, when a person cannot walk (in the intensive care unit, during surgery), their use is permissible around the clock, and therapeutic or prophylactic, used in people with preserved motor activity from 1st to 3rd compression class depending on the indications;
• Elastic bandages – effective method prevention only with skillful bandaging, an incorrectly applied bandage increases the risk of thrombosis, and in conditions where bandaging is performed with average medical personnel or independently - of course, priority is given to compression hosiery as a safe and reliable means;
• Pneumatic compression - cuffs are placed on the lower extremities (foot and/or lower leg), which periodically compress, by increasing the air pressure inside themselves, the extremities, simulating the work of the venous muscle pump of the legs, as when walking;
• Electromuscular stimulation - through weak electrical impulses, the calf muscles are forced to contract, which repeats the work of the venous muscle pump when walking.

Conclusion

Venous thrombosis and thromboembolism are fatal dangerous conditions, requiring careful and attentive prevention, the success of treatment, as well as the life and well-being of the patient, largely depends on a qualified and comprehensive approach to the prescription of which.

Prevention of venous thromboembolic complications in surgical practice

A.I.Kirienko, S.G.Leontiev, I.S.Lebedev, E.I.Seliverstov
Department of Faculty Surgery of the Russian State Medical University (head - academician V.S. Savelyev), city clinical Hospital No. 1 named after N.I. Pirogova (chief physician - Prof. O.V. Rutkovsky)

Often, massive pulmonary embolism, the mortality rate of which ranges from 0.1 to 5%, is the first manifestation of asymptomatic acute phlebothrombosis. A similar course of thrombosis, according to T.Hyers, in postoperative period observed in 80% of patients. According to the pathological-anatomical department of City Clinical Hospital No. 1 named after. N.I. Pirogova, massive pulmonary embolism after urological, surgical, gynecological interventions is detected in 7.1, 8.3 and 11.2% of cases, respectively. In addition, approximately half of patients with popliteal or femoriliac thrombosis experience asymptomatic pulmonary embolism. Unverified thromboembolic complications threaten to occur in the long term severe forms chronic venous insufficiency of the lower extremities and post-embolic pulmonary hypertension, which negatively affects the quality of life and requires significant financial costs for their treatment. In this regard, the issues of preventing thromboembolic complications in surgical patients are still relevant.

These data force the clinician to answer the question: what is the likelihood of developing venous thrombosis and pulmonary embolism in this particular patient? To do this, it is necessary to analyze the totality of risk factors that predispose to the occurrence of VTEC in the postoperative period. They are determined, on the one hand, by the surgical intervention, and on the other, by the nature of the pathology (including concomitant ones) present in the patient. The risk of complications depends most on the type of surgery and its duration. There are uncomplicated interventions (lasting from 30 to 45 minutes), large and extended. The first include appendectomy, hernia repair, curettage of the uterine cavity, hysteroscopy, transurethral resection of the prostate gland, diagnostic laparoscopy and endoscopic operations, etc. It is a deep misconception that they are never accompanied by VTEC. Thus, in this category of patients, the frequency of deep vein thrombosis of the leg reaches 2%, proximal forms of thrombosis - 0.4%, pulmonary embolism develops in 0.2% of patients with a fatal outcome in 0.002% of cases. Venous thrombosis and pulmonary embolism are reported after laparoscopic cholecystectomy in 0.03 and 0.06% of patients, respectively.

Major interventions in which thrombosis most often occurs in the inferior vena cava system include: complicated appendectomy, cholecystectomy, resection of the stomach or intestines for diseases of non-tumor etiology, cesarean section, uterine amputation, removal of appendages, transvesical adenomectomy, plaster immobilization or osteosynthesis of shin bone fractures, etc. A serious problem remains the lack of proper preventive measures after surgical delivery.

Extended interventions, after which the frequency of thrombosis of distal localization reaches 40-80%, proximal - 20%, and pulmonary embolism develops in 4-10% of patients, include operations performed for malignant neoplasms of any localization, orthopedic or traumatological (hip osteosynthesis, endoprosthetics of the knee or hip joints). The high probability of developing venous thrombosis in these patients is due, on the one hand, to the presence of oncopathology, one of the main independent risk factors, and, on the other hand, to the duration and volume of the intervention, long-term immobilization both before and after surgery.

The number of factors associated with the patient's condition and influencing the incidence of VTEC is enormous. The main ones include: age, history of cancer, episodes of venous thrombosis and pulmonary embolism, prolonged (4 days or more) bed rest, obesity, varicose veins of the lower extremities, hormonal contraceptives, hereditary or acquired thrombophilic conditions. Often, it is concomitant pathology, other things being equal, that significantly increases the risk of acute venous thrombosis. For example, in the older age group, the incidence of thromboembolic complications is 3-4 times higher than in patients 40-50 years old. The fact that oral contraceptives, increasing the content of fibrinogen in the blood plasma, as well as coagulation factors such as prothrombin, VII, IX, X, XII, increase the risk of thrombosis, there is no doubt. Thus, patients can be divided into groups with low, moderate or high risk of venous thrombosis. The choice of prevention methods should be carried out according to the degree of risk.

The postulate that complications are easier to prevent than to treat is well known. In this regard, it must be especially emphasized that preventing the development of venous thrombosis means thereby protecting the patient from life-threatening pulmonary embolism. According to Virchow's triad, activation of the blood coagulation process occurs as a result of changes in its properties (hypercoagulation), damage to the vascular wall, and a slowdown in blood flow (stasis). The basis of prevention are methods aimed at correcting these disorders and preventing the development of acute venous thrombosis. They are divided into medicinal (pharmacological) and physical (mechanical).

Physical methods of prevention should be used in all patients without exception in the intra- and postoperative period until full activation. They include elastic compression of the lower extremities and intermittent pneumatic compression. In this case, there is a decrease in the venous capacity of the lower extremities, an improvement in the speed and viscosity characteristics of the blood. Methods for accelerating blood flow are especially effective in neurosurgical patients, in patients with concomitant trauma, when pharmacoprophylaxis is tantamount to a “disaster” due to the risk of hemorrhagic complications. For example, perioperative variable pneumocompression in neurosurgery reduces the incidence of venous thrombosis from 22 to 7%. The level of compression also plays an important role, especially in high-risk patients. According to A. Howard et al. (2004), compression of the entire limb reduces the incidence of thrombosis by 2.5 times (see table). We should not forget that one of the components of non-drug prevention of VTEC is the maximum and possibly earlier activation of patients who have undergone surgical interventions. In this regard, it is necessary to note the advantages of regional anesthesia over general anesthesia in reducing the incidence of these complications, especially in traumatological and orthopedic patients.

Table. The influence of compression level on the incidence of postoperative thrombosis

Thanks to its action, Aspirin ensures normal blood circulation in the vessels and prevents the risk of clots.

It is caused by a blood clot that develops in an artery. When arterial thrombosis occurs in the coronary arteries, it can cause heart attack in humans. When this occurs in the cerebral circulation, it can cause or lack of oxygen to other organs.

Anyone can get thrombosis, although the disease usually develops in older people. There are a number of factors that contribute to the development of this disorder, including family history, inactivity and obesity. Often thrombosis develops with little or no symptoms in an individual and is often referred to as a silent disease. Often venous veins most often suffer from thrombosis, and frequent symptoms, such as severe pain, swelling of the leg, redness, warmth in the area, tightening of the leg muscles and the formation of painful nodules in the varicose veins.

For people who have not previously encountered vascular diseases, taking Aspirin is also indicated. It is recommended to take this medication in the following cases:

For preventive purposes, it is recommended to take Aspirin in small doses - a quarter of a tablet per day after meals.

Therefore, it is important to know the signs and risk factors for thrombosis. The specific treatment for thrombosis will be determined by the physician based on the patient's age and general condition, the extent and type of thrombosis, and their tolerance to medications, procedures, or therapies. Treatment may include medications such as heparin, catheters, and others.

It is recommended to prevent thrombosis. To avoid thrombosis after surgery, it is recommended to begin walking slowly immediately after the doctor releases it, move your legs and feet while lying down, and take blood thinning medications to make the blood thinner, such as heparin.

It's important to remember that simultaneous administration anticoagulants indirect action and Aspirin is contraindicated, as there is a risk of bleeding.

Like any medicine, Aspirin has contraindications, so its use should be agreed with the treating specialist. It is contraindicated to take Aspirin in the following cases:

Thrombosis, which is the formation of clots or blood clots inside the blood vessels of the legs, can occur after surgery after surgery, especially when it is complex or takes more than 30 minutes, such as heart or abdominal surgery, as it occurs in bariatric surgery.

What to do after surgery to prevent thrombosis

This is because immobilization during surgery causes the blood to become thicker and clots to develop, which in most cases form within the first 48 hours after surgery until the 7th postoperative day, causing redness of the skin, pain and pain in the legs. More symptoms in: Deep vein thrombosis. To prevent the occurrence of thrombosis after surgery, the doctor should indicate.

The dosage and frequency of taking the medicine can be individual, depending on the condition of the blood and the predisposition to clot formation. In cases of postoperative deep vein thrombosis, taking Aspirin is mandatory for 90% of patients for preventive purposes. In this case, the dose is often increased to half a tablet per day for 5-7 days.

Walk as soon as possible: A patient undergoing surgery should walk as soon as he or she has little pain and there is no risk of scar breakdown as moving the blood reduces the risk of thrombosis. Elevate your legs: This method facilitates the return of blood to the heart and reduces swelling in the legs; leg exercise: the patient should move the legs and legs, bending and stretching about 3 times a day, elastic stocking: the doctor may recommend the use of compression stockings even before surgery, and they should only be taken after a week to make body hygiene; Every 3 hours. Usually the patient can walk after 2 days, but this depends on the operation. . These readings should be maintained for at least the first week to avoid blood clots and major operations for up to 3 weeks in accordance with medical indications.

Preventing blood clots with other medications

As a rule, prevention of thrombosis without taking medications for people prone to deep vein thrombosis is unrealistic. Patients who have previously suffered thrombophlebitis of the lower extremities are required to regularly take anticoagulants and use external agents.

In addition, the doctor may recommend electrical stimulation of the calf muscles and intermittent external pneumatic compression, which is provided through devices that stimulate blood flow in patients who are unable to move the legs, such as comatose people.

Factors that increase the risk of thrombosis after surgery

However, other factors may increase the risk of deep venous thrombosis after surgery, e.g. When a blood clot develops due to surgery, there is a high chance of developing a pulmonary embolism because the clots reduce or block the passage of blood by remaining in the lungs.

Most blood thinners are available with a prescription. The dosage of anticoagulants is prescribed by the attending physician, based on the results of a blood test.

The most effective anticoagulants are Sinkumar, Phenilin, Warfarin. Any of these remedies can be used to prevent the formation of clots in the vessels of the lower extremities, as well as during and after treatment for deep vein diseases. Patients with a chronic tendency to blood clotting need to take anticoagulants throughout their lives.

In addition, the legs may have swelling, varicose veins and brownish skin, which in more severe cases can lead to gangrene, which is cell death due to lack of blood. It is estimated that about 40% of patients hospitalized and undergoing complex operations will develop it.

Thrombosis is known to be characterized by blood clotting in the deep veins. These clots attach to the walls of blood vessels and cause partial or complete obstruction of the blood vessels. The areas most affected by thrombosis are usually the legs and thighs, but when one of these clots breaks loose and reaches the lungs, it is called a plunger and can cause a blockage that can lead to a pulmonary embolism, which can lead to sudden death.

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IN normal conditions blood has a natural tendency to clot to prevent bleeding. However, certain factors are responsible for triggering or favoring the abnormality: genetic predisposition, old age, high cholesterol, long surgeries and hospitalizations, obesity, use of contraceptives, lack of exercise, alcohol consumption and smoking.

People who fit these characteristics constitute a risk group. Thrombosis can cause symptoms such as pain, swelling and warmth in the legs, dark red or purple coloration, hardening of the skin, and even shortness of breath and dizziness. If suspected, a doctor should be consulted immediately.

The average course of taking anticoagulants is 6 weeks, but with regular monitoring of the patient’s blood condition. Taking such drugs is contraindicated in the following groups of people:

The main side effect of blood thinners is the risk of bleeding. That is why the doses of drugs are always small.

However, it can develop completely asymptomatically, i.e. with no visible symptoms, making it a silent disease and a difficult diagnosis. In addition, blood clots are usually caused by one of the following: Endothelial lesions, i.e. wounds on the walls of blood vessels; Increased blood viscosity, when the blood becomes denser; decreased blood flow, that is, blood circulation slows down. Thrombosis is more common in the lower extremities because they are further away from the heart, making blood circulation in that region slower than the rest of the body.

In addition, blood must work against gravity to return to the heart. Therefore, usually, the formation of blood clots occurs in the veins of the legs. Once freed from the lining of the veins or arteries, the clot becomes a plunger. It circulates freely through the blood until the vessels become thin, making it impossible for them to pass through. Imprisoned, the plunger clogs the vessel and impairs blood circulation. This is more likely to happen in the lungs, since that is where the narrowing occurs first. It is at this point that shortness of breath may occur.

External applications include various creams and gels. Some of them are able to eliminate blood clots in the lower extremities, others - tone the blood vessels. The use of creams for the prevention of venous diseases consists of daily application of the composition to the affected area.

For diseases of the deep veins, thinning creams are used that can eliminate the clot and prevent the formation of a new one. For varicose veins of the lower extremities, gels are often used to strengthen the walls of blood vessels.

However, if the plunger passes smoothly through the lungs, any part of the body will be susceptible to clogging the artery. There are several tips that can help prevent the onset of thrombosis. They should be taken mainly by people at risk. Avoid very tight clothing. Regarding bandaging, the use of elastic compression stockings is a strong ally in preventing thrombosis, improving circulation and relieving the symptoms of tired legs.

Cigarette components cause injury to veins and arteries, so it is important to stop smoking, especially before surgery, whatever it may be. Some foods, especially fruits and vegetables, can prevent platelet aggregation and blood clot formation. Hence the importance of a regulated diet and, of course, the practice of regular exercise to maintain blood circulation.

Among the pharmacy assortment, Venolife, Heparin ointment, and balsamic liniment (according to Vishnevsky) are recognized as the most effective thinning creams. The creams have indications for use in thrombophlebitis of the deep veins of the lower extremities, post-injection thrombosis, varicose veins and for the prevention of any venous diseases.

Speaking of physical activity, keep moving and don't stay in the same position for long periods of time, such as while working or traveling on a plane, as this can impair circulation. If you don't have time for daily walks, try simple calf exercises. A good example is the up and down leg movement: it is effective and can be done while sitting, lying down or even standing.

To treat thromboembolism, you need to stimulate circulation. This can be done with anticoagulants or compression stockings. The drugs work directly in the blood to prevent bleeding from clotting, while the elastic stockings treat the leg muscles, which in turn press on the veins to help them force blood back up to the heart.

Creams that tonic blood vessels also relieve swelling of the lower extremities after a hard day and bring a feeling of lightness to the legs. The most popular venotonics are Lyoton-gel, Troxevasin, Venoruton.

It contains amaranth seeds and juice, and others natural ingredients, which effectively fight blood clots, lower cholesterol levels, normalize the tone of the veins, cleanse the blood and lymph, prevent the deposition of cholesterol plaques, and improve the general condition of the body. Only natural ingredients are used, no chemicals or hormones!

The drugs are used in preventive measures for chronic venous insufficiency, after suffering any types of thrombosis, including deep veins. When used by patients with postoperative thrombosis, venotonics promote faster tissue recovery.

Drugs local application should be applied daily 2 times a day. If there is a risk of clots forming in the deep veins, thinning creams are applied as a bandage and not removed for 2-3 hours.

Firming and toning gels are applied thin layer on the lower limbs and rub until completely absorbed. In case of violation of the integrity of the skin (wounds, abrasions, ulcers), the gel must be applied around the damaged area.

It is important to remember that creams, like any medicine, have contraindications for use, so before starting use, you should consult a doctor.

Other methods of prevention

To prevent impaired blood circulation in the lower extremities, compression hosiery is widely used. Various compression stockings, knee socks and bandages can always be purchased at pharmacies.

For postoperative thrombophlebitis, the use of compression is mandatory for several months. For varicose veins of the lower extremities, compression stockings are recommended to be worn daily.

Elastic knitwear perfectly supports blood vessels and promotes normal blood flow. Regarding the risk of clot formation in deep vessels, we can say that the use of compression is mandatory throughout the patient’s life.

The only one important point when used compression hosiery is right choice laundry size. This method of prevention has no contraindications.

No less significant moment in the prevention of diseases of the venous system is the lifestyle and nutrition of the patient. Daily exercise and use necessary products can significantly reduce the risk of blood circulation disorders. The main points in the daily prevention of the disease are the following measures:

Regarding nutrition to prevent the risk of clots in blood vessels, we can talk forever. Let's list the most available products, which makes sense to add to the diet of any person who has concerns about the occurrence of thrombosis:

Any of these products will reduce the risk of blood viscosity and normalize its composition. It is also worth eliminating smoking, alcohol, smoked foods and fatty foods from everyday foods.

Do you still think that it is impossible to RECOVER COMPLETELY?

Have you been suffering for a long time from heaviness in your legs and swelling that worsens towards the end of the day, constant headaches, migraines, severe shortness of breath at the slightest exertion, and plus all this pronounced HYPERTENSION? Did you know that all these symptoms may indicate an increased level of CHOLESTEROL in your body, which can lead to BLOCKS?

Judging by the fact that you are reading these lines now, the fight against pathology is not on your side. Now answer the question: are you satisfied with this? Can all these symptoms be tolerated? How much money and time have you already “wasted” on ineffective treatment of SYMPTOMS, and not the disease itself? After all, it is more correct to treat not the symptoms of the disease, but the disease itself! Do you agree?

Currently, according to official statistics, the risk of developing acute thrombosis is present in every third inhabitant of our planet, regardless of his age, race and gender. Over the years, this figure is only growing and, according to experts, after 55 years, every second patient turns to doctors with clear signs of increased activity of the blood coagulation system.

This cannot but be alarming. After all, thrombotic clots are one of the main causes of the development of acute myocardial infarction, ischemic stroke of the brain, pulmonary embolism, thrombophlebitis of the veins of the lower extremities, and the like. Most of these pathological conditions not only worsen a person’s quality of life, but also seriously threaten his health, risking death.

In connection with this trend, today effective prevention of thrombosis is one of the main tasks modern medicine, to which scientists devote a lot of time, looking for new ways to solve it.

Formation of blood clots in blood vessels - pathological process the formation of blood clots in the arteries, veins and capillaries of the human body. This happens due to a violation of the natural balance between the functionality of the coagulation and anticoagulation systems of the blood, which may be caused by the action huge amount external as well as internal factors, including:

• genetic predisposition;
• age over 50-55 years;
• diseases of the cardiovascular system: arrhythmias, congenital aneurysms, aortic aneurysm, venous valve insufficiency, etc.;
• extracardiac pathology: kidney disease, liver disease;
• blood ailments associated with increased blood clotting, an increase in the number of platelets and red blood cells;
• metabolic disorders in the body, which are manifested by diabetes mellitus, obesity, atherosclerosis;
• injuries of various origins, including surgical interventions;
• cancer and several courses of chemotherapy;
• septic conditions caused by the spread of infection throughout the body;
• bad habits, including alcoholism, drug use, smoking;
• general hypothermia;
• sedentary lifestyle, sedentary work, bed rest;
• taking hormonal contraceptives.

Prevention of thrombosis of veins and arteries largely depends on the cause and mechanisms in the vessels, the favorite localization of which is the heart, as well as the lower extremities. First, a small blood clot appears in the lumen of the vessel. A similar phenomenon happens to every living person, but for most of us, such primary blood clots resolve on their own without causing harm to health. If blood coagulation increases, the clot becomes overgrown with formed elements, becomes saturated with fibrin and increases in size. Over time, such a thrombus blocks the lumen of the vessel and causes organ ischemia.

The process of blood clot formation

When wondering how to prevent the formation of blood clots, you should understand that their formation is facilitated by several causative factors, namely changes in blood density, damage to the vascular wall and congestion. Blood clots can be avoided only by eliminating this chain of pathological processes. Understanding the causes of blood clots will help a person create the most for his body. comfortable conditions life, what is important step on the way to preventing thrombotic disease.

Basic preventive measures

How to avoid thrombosis? Doctors have to hear this question every day, since many patients today prefer to prevent illnesses and are more attentive to their health. Experts always emphasize that the prevention of vascular thrombosis must be comprehensive and timely. Only in this case will it be effective and prevent the formation of clots in the bloodstream.

Particularly relevant is the prevention of blood clots in people who have genetic predisposition to the development of the disease or have 1-2 factors predisposing to the occurrence of symptoms of increased blood clotting.

Modern prevention of vascular thrombosis includes a number of measures aimed at improving the rheological properties of blood, preventing heart and vascular diseases, strengthening blood vessels, normalizing blood flow, and the like. So, to avoid blood clots, patients should adhere to the following rules:

• adhere to a special diet aimed at preventing the formation of blood clots;
• give up bad habits and spend more time outdoors;
• combat physical inactivity by organizing, together with a specialist, the most comfortable training regimen and adequate physical activity;
• strengthen the immune system, which will prevent the development of infectious processes;
• wear if necessary compression socks, knitted stockings specially designed for the prevention of thrombosis;
• correctly organize the daily routine, carefully plan long trips in vehicles, airplanes, where you need to spend many hours in a sitting position;
• refuse to wear outerwear, underwear and accessories that cause discomfort and put pressure on certain parts of the body (this applies to tight jeans, belts, corsets, uncomfortable shoes, etc.);
• avoid general hypothermia and absenteeism in hot weather;
• try not to take too hot baths;
• consult a doctor to prescribe medications to prevent thrombosis, including acetylsalicylic acid, B vitamins, vitamin C (you cannot take medications whose dosage has not been previously agreed upon with a specialist).

How to organize your diet correctly?

Prevention of blood clots includes organizing correct mode nutrition with the introduction of foods that help thin the blood into the diet. People who have been identified as having an increased risk of development should eat a diet aimed at reducing blood cholesterol levels, enriched with fiber and containing in the right quantities all the substances necessary for the full functioning of the human body.

Prevention of thrombosis and vascular diseases with the help of diet therapy should include the mandatory introduction into the daily diet of foods with a high content of substances such as:

• polyunsaturated omega-3 fatty acids, which are found in sea ​​fish, fish oil, vegetable oils;
• bioflavonoids, blood thinners, the leader in content of which is red grapes;
• natural antioxidants, the most famous representative of which is vitamin E, can be found in flax seeds, flaxseed and olive oil, sprouted wheat grains and the like;
• plant fibers for normal intestinal functioning and elimination of toxins.

The list is very wide and varied, so such prevention of blood clots in blood vessels will not make a person’s diet poor, causing him to experience a shortage of one or another substance.

Naturally, there is also a certain amount of food that can harm human health, trigger pathological blood clotting mechanisms and contribute to the formation of blood clots in blood vessels. That is why doctors strongly recommend excluding the following dishes from the daily menu of patients who care about the health of their veins and arteries:

• fatty dishes fried in animal fats, as well as smoked meats, sausages, pates and canned food;
• various kinds confectionery, sweet cakes, pastries with large amounts of sugar added, chocolates;
• offal and semi-finished products;
• butter, margarine, hard cheeses, full-fat dairy products;
• egg yolks in quantities of more than 4 per week;
• alcoholic and carbonated drinks.

Prevention of thrombosis in the postoperative period

The question of how to prevent thrombosis in people after undergoing operations is quite relevant for modern medicine. This is due to an increase in mortality from sudden manifestations of the disease in patients in the postoperative period. According to research, the risk of developing a pathological condition in such patients increases with age and is a practically uncontrollable process, which can only be prevented by competent prevention of thrombosis of veins and arteries before and immediately after surgery.

Today there are ways to prevent thrombosis in the postoperative period, such as:

• the use of minimally invasive surgical techniques in surgical practice to reduce blood loss and soft tissue injuries;
• wearing compression hosiery, which helps prevent deep vein thrombosis of the lower extremities;
• ensuring early getting up with attempts to walk already 2-3 days after surgery;
• reception medications for blood thinning, including acetylsalicylic acid, antiplatelet agents, vitamins B10, B12;
• pneumatic massage on the lower extremities.

Pneumatic foot massage

Patients with visible dysfunction of the blood coagulation system who are being prepared for surgery are advised to consult a specialist with the prescription of injectable drugs from the group of anticoagulants, which will prevent thrombosis and reduce the risks of life-threatening conditions.

Today, the problem of thrombosis of veins and arteries affects every second inhabitant of our planet over the age of 45 years.

To a greater extent, the pathological process tends to accumulate in the vessels of the legs, so the prevention of deep vein thrombosis of the lower extremities is an issue more relevant than ever, and experts do not recommend delaying it. Only competent and professional prevention thrombophlebitis of the lower extremities, as well as treatment of already formed blood clots, will allow patients to avoid the most severe consequences of the disease, which very often threaten their lives.

Thromboembolic complications: types, causes and degrees of risk, detection, treatment and prevention

Thromboembolic complications are a rather serious problem in surgery because they not only cause severe course postoperative period, but can also lead to sudden death of the patient. According to statistics, about 100 thousand patients in Russia die annually from sudden Mortality due to the development of massive pulmonary embolism is about 5%. Thromboembolism is represented by blood clots that form in the lumen of blood vessels and spread with the blood flow throughout the body. More often, blood clots form in the lumen of the veins of the lower extremities, and then enter the right half of the heart and then into the arteries of the lungs.

Regardless of the size of the blood clot, an artery of one diameter or another is blocked, as a result of which the area of ​​the lung tissue supplied with blood by the branches extending from the blocked artery does not receive proper nutrition, and the tissue dies. The larger the thrombus, the wider the lumen of the blocked artery, the larger number branches do not receive blood, the more cells in a larger area of ​​the lung die. Death, or necrosis, of cells is called. This is a pathognomonic morphological sign for pulmonary embolism (PE).

pulmonary embolism followed by pulmonary infarction

If a pulmonary infarction due to obstruction of the pulmonary artery by a thrombus leads to damage to a large amount of lung tissue, acute cardiopulmonary and respiratory failure occurs, which without treatment it is fatal. That is why the prevention of thromboembolism in the postoperative period is one of the pressing problems of surgery.

But pulmonary embolism poses a danger to not only surgical patients, but also urological, traumatological, gynecological and obstetric patients. That is, for all patients who are planning or have already undergone surgery.

In addition to pulmonary embolism, thromboembolic complications include thrombosis of the inferior vena cava and acute lower limbs. These thromboses are not only the immediate background for the development of pulmonary embolism, but also in themselves pose a threat to the patient's health.

thrombosis of deep veins of the leg (left) and inferior vena cava (right)

Causes of thromboembolism

The causative factors of venous thromboembolic complications (VTEC) can be divided into disturbances of normal blood flow in the veins of the lower extremities, as well as predisposing factors.

The first group of reasons includes all factors that contribute to the activation of the so-called Virchow triads, the essence of which is as follows. The formation of a blood clot in the lumen of a vessel is possible if the blood flow in the vein slows down, there is a violation of the integrity of the vascular wall, and there is also a tendency to. All of these conditions occur during the early postoperative period in patients with conditions requiring emergency or elective surgery.

Thus, the development of VTEC is possible in the following conditions (the percentage of patients with venous thromboembolic complications out of the total number of those operated on is indicated in parentheses):

• Operations on the abdominal organs, including therapeutic or diagnostic laparoscopy (19)%,
• Gynecological operations, including therapeutic and diagnostic curettage of the uterine cavity and cesarean section (11.2%),
• Urological operations, including resection of prostate adenoma (7.1%),
• Neurosurgical operations (24%),
• Operations regarding malignant tumors various localization (30%),
• Prosthetics of the knee or hip joints, as well as combined trauma and fractures requiring surgery or long-term immobilization (immobilization) of the patient (84%).

Predisposing factors include:

1. Gender - in women, blood clots form in the veins more often due to hormonal characteristics,
2. Age - the older the person, the higher the likelihood of blood clots in the veins,
3. Lifestyle - “sedentary” and sedentary work contribute to stagnation of blood in the veins,
4. Presence in the lower extremities - the more nodes and the higher the incompetence of the vein valves, the slower the blood flow through the vessel and the higher the tendency to platelet aggregation,
5. Taking hormonal contraceptives (COCs - combined oral contraceptives), which significantly change rheological properties blood,
6. Hereditary disorders of the blood coagulation system - thrombophilia, or a tendency to increased thrombosis.

How to assess the risk of VTEC?

Any surgical doctor planning surgical intervention for his patient must be able to assess the risks of thromboembolic complications, and in particular, the risk of developing pulmonary embolism.

The risk assessment of VTEC is determined based on the nature of the surgical intervention:

• Low risk thromboembolic complications in the postoperative period in surgical patients are characterized by uncomplicated minor operations. The risk of pulmonary embolism during surgery is less than 0.2% of all those operated on, including 0.002% of deaths as a result of massive thromboembolism. These include laparoscopic interventions and transurethral urological manipulations on the prostate.
• Medium risk with an incidence of thrombosis in less than 5% of operated patients, typical for major operations. These include removal of the gallbladder, appendectomy with complications (phlegmonous, gangrenous appendicitis), cesarean section or amputation of the uterus, removal of part of the stomach or intestines, removal of prostate adenoma with transvesical access.
• To interventions that are accompanied high frequency of VTEC(more than 80% of thrombosis in the deep veins of the legs, more than 40% of thrombosis in the inferior vena cava and more than 10% of pulmonary embolism, including fatal ones), include advanced operations - removal of malignant tumors, traumatological and orthopedic operations with joint replacement, as well as neurosurgical interventions.

In this regard, the first group of operations implies a low degree of risk of VTEC, the second group - a moderate degree of risk, and the third group - a high degree of risk of VTEC.

What are the symptoms of thromboembolic complications?

patient with pulmonary embolism

Typically, pulmonary embolism of small branches is accompanied by attacks of dry cough or hemoptysis with pain in the chest various localizations. Often the patient experiences attacks of sudden shortness of breath and a feeling of lack of air. Loss of consciousness may be present.

Massive pulmonary embolism is characterized by pronounced pain syndrome in the chest, shortness of breath, hemoptysis and cyanosis (blue discoloration) of the skin of the face, neck, earlobes and chest strictly up to the horizontal line between the nipples. Clinical death can occur instantly, which without treatment turns into biological death. In some cases, the patient may simply get up and die.

Diagnosis of VTE

The diagnosis of deep vein thrombosis of the leg or inferior vena cava can be confirmed using vascular ultrasound.

X-ray signs of pulmonary embolism (Fig.: NSC “Institute of Cardiology N.D. Strazhesko”)

PE is confirmed by chest x-ray, but the absence of characteristic x-ray signs does not justify excluding the diagnosis. In other words, the diagnosis of thromboembolism, even with a normal chest x-ray, can be established on the basis of clinical data.

A mandatory study for suspected VTEC is a blood test for, as well as a study of the blood coagulation system (indicators, fibrin, blood clotting time, a,).

After a comprehensive assessment of the data obtained, treatment begins.

Treatment of thromboembolic complications

Any doctor must remember that mortality rate for massive pulmonary embolism without treatment is more than 90%, therefore, therapy should be started as early as possible.

The main principle of treatment is to dissolve the blood clot and correct the blood clotting disorder. In this regard, in the intensive care unit the following drugs are administered intravenously to the patient:

• Low molecular weight heparins - heparin at a dose of 31-33,000 units/day for 5-7 days or enoxaparin at a dose of 180 mg/day for 5-7 days,
• Drugs for this procedure are streptokinase at a dose of 250,000 units in the first 30 minutes, then 100,000 units on the first day or alteplase at a dose of 100 mg on the first day.

Of the tablet preparations, it is used in a dose of 10 mg for 5-7 days.

vena cava filter that catches blood clots

If there are indications, the patient can undergo surgical treatment of thrombosis - installation of the inferior vena cava into the lumen or embolectomy of the inferior vena cava.

The indications for surgery are the following:

1. Recurrent pulmonary embolism during adequate anticoagulant therapy,
2. Extensive or progressive thrombosis of the inferior vena cava,
3. Planned or performed surgery in a patient with a history of pulmonary embolism.

Prevention of thromboembolic complications

Preventive measures against thrombosis and thromboembolism can be divided into physical and pharmacological.

The first group includes early activation of the patient after surgery (on days 2-3), wearing compression stockings before and after surgery, as well as intermittent pneumocompression. Wearing it prevents blood stagnation in the veins of the lower extremities, which significantly reduces the risk of thrombosis. Thus, wearing elastic knee socks reduces the risk of pulmonary embolism by up to 8.6% in patients with high degree risk, while wearing stockings up to the groin - up to 3.2%. Wearing compression garments in patients with low and moderate risk of VTEC reduces the risk of thrombosis and thromboembolism to generally 0%.

Compression hosiery can be purchased for all patients planning to undergo surgery at a pharmacy or orthopedic salon. If the operation was performed for emergency reasons, the patient’s relatives should give him stockings or stockings as soon as possible after the operation.

Intermittent pneumocompression is the application of a cuff that pumps air alternately onto the ankle and thigh with different pressures - 20 mm Hg in the lower leg area and 35 mm Hg in the thigh area. This helps improve blood flow through the veins of the lower extremities.

Pharmacoprophylaxis is carried out using early subcutaneous administration of heparin (already two hours before surgery, 5000 units), and then administration at a dose of 5000 units x 3-4 times a day for 7-10 days. In addition, patients who do not have contraindications for taking warfarin receive it at a dose of 2.5 mg/day for 1-1.5 months.

Prescription of preventive measures should be based on probability depending on various risk factors.

The likelihood of developing thromboembolism after surgery:

1. Replacement of the knee apparatus with a prosthesis – from 60 to 85 percent;
2. Introduction of the prosthesis into the hip joint – from 30 to 69 percent;
3. Arthroscopy – about 20 percent;
4. Benign tumors - from 25 to 30 percent;
5. General operations – from 20 to 30 percent;
6. Low-quality tumors - from 30 to 35 percent;
7. Gynecological surgeries – from 15 to 23 percent;
8. Interventions in the field of urology - from 10 to 35 percent;
9. Neurosurgery - about 25 percent;
10. Spinal cord surgeries – from 65 to 90 percent.

Also, the risk of blood clots increases significantly due to acquired factors. Among them are:

1. Surgical operations – six times;
2. Oncological pathologies – seven times;
3. Infectious diseases - ten times;
4. Heart pathologies – eighteen times;
5. Hypertension – twice;
6. Excess body weight – four times;
7. Varicose veins – three times;
8. The course of pregnancy is four times;
9. Long trips – four times;
10. Deep vein thrombosis and thromboembolism pulmonary artery– eight times.

Experts also identify a number of predisposing factors. Among which are noted:

• age group of people over fifty years of age;
• passive lifestyle;
• childbirth with complications;
• injuries;
• use of hormonal contraceptives;
• predisposition at the genetic level;
• inflammatory diseases.

Based on the above factors, experts divide patients according to the degree of risk of developing thromboembolism.

They are divided into the following groups:

1. Low– there is minimal surgical intervention and the absence of other risk factors.
2. Moderate– the age group of people over forty years old with significant surgical intervention. As well as patients under forty years of age with the addition of other risk factors.
3. High– minimal surgical intervention in older patients age group(from sixty years old). And also people with low-quality tumors, with diagnostic tests diagnosing the formation of blood clots in the deep veins of the legs and pulmonary embolism.
4. Highest– patients over sixty years of age with a diagnosed malignant tumor.

To identify an individual patient to a specific risk group, specialists use a scoring system for taking into account risk factors. In this case, any factor is equal to one.

When observing one point, the patient belongs to a group with a low risk, from two to four points - to a moderate one. From four to six – high. If you have more than six points, you are assigned to the highest risk group.

Methods for diagnosing pulmonary embolism

And its prevention is quite a difficult task. To diagnose it, the formation of a blood clot should be assumed. Taking into account the medical history of an individual patient, experts draw a conclusion about the presence of risk factors.

Having analyzed the available surgical interventions and the presence of previous heart attacks, we can draw a conclusion about the location of the initial formation of the blood clot.

In the future, necessary examinations for or its exception. They are divided into the following categories.

Mandatory

Measures taken for all patients with suspected pulmonary embolism. The examination package includes an electrocardiogram, lung scintigraphy, radiography, echocardiography, and ultrasound of the veins of the lower extremities.

Additional

Assigned upon request to clarify individual indicators. Such examinations include pulmonary angiography, measurement of pressure in the pulmonary artery, atrium and ventricles, and others.

Laboratory studies of patient tests are carried out to record the following indicators:

• erythrocyte sedimentation rate;
• amount of bilirubin;
• value of leukocytes;
• fibrinogen indicators.

With pulmonary embolism, the indicators in question significantly increase their concentration in the patient’s blood.

The use of radiography does not allow an accurate diagnosis. This method allows you to distinguish thromboembolism from other diseases that have identical symptoms.

Put accurate diagnosis allows the study of the electrocardiogram in conjunction with the patient's medical history. In this case, according to the electrocardiogram data, one can draw a conclusion about the degree of development of the pathology.

Echocardiography is intended to determine the initial location of the thrombus, as well as to clarify its size and shape.

Lung scintigraphy provides a significant amount of information about the condition of the blood vessels of the lungs. Disadvantage this method is the impossibility of determining the location of a blood clot in small vessels.

At this point in time, the most accurate way to diagnose thromboembolism is angiography. Its use allows you to see an empty vessel, which indicates its blockage.

For staging correct diagnosis, specialists study the data of several examinations, and also take into account the patient’s medical history.

Preventive measures for thromboembolism

Based on the studied data on the presence of risk factors in an individual patient, specialists can prescribe the following types of prevention:

1. Non-medicinal.
2. Medication.
3. Prevention in the postoperative period.

Non-drug prevention

The most common exclusion method possible education blood clots is a speedy transition from bed rest to active image life. In the process of gradually increasing physical activity, the likelihood of venous stagnation is eliminated.

Elastic compression of the legs is also used. Elastic stockings or knee socks can be used for this. Their use allows you to stabilize blood circulation, while maintaining pressure along the entire length of the damaged limb.

Knitwear designed in medical purposes, intended for the prevention of thromboembolism. Popularly called anti-embolic. When it is applied, the required pressure is created, measured in millimeters of mercury.

Subsequently, it gradually decreases, which helps prevent blood stagnation. This knitwear retains its compression properties for a long time. Easy to use and has good medical properties.

The following contraindications exist:

• significant deformation of the lower extremities;
• the presence of varicose ulcers;
• pathologies of elastic and muscular-elastic arteries;
• with an ankle circumference of more than thirty-five centimeters.

Variable pneumatic compression is also used. To carry out this procedure, a special compressor with cuffs is used, which are divided into several separate chambers.

This design allows you to consistently create pressure on the leg, which significantly increases blood flow in the veins.

Drug prevention

Prophylaxis of thromboembolism with the help of drugs is the prescription of complex drugs.

Unfractionated heparin increases the effectiveness of the natural coagulant (antithrombin). At the same time, it is extremely difficult to make an accurate forecast of its effects, since its effect depends on many factors (age, body weight, gender, condition of internal organs, and much more).

As a rule, the prophylactic use of unfractionated heparin consists of its subcutaneous administration. In this case, there is no need to conduct constant analysis of laboratory parameters.

Exceptions are made for patients in the highest risk group. This is due to the fact that the dosage used increases. Experts prescribe the following medications from the group under consideration: Lyoton, Heparin Acrigel.

Drugs in this group have the following side effects:

• the formation of osteoporosis with a long course of use;
• induced

Low molecular weight heparins have a similar mechanism of action to unfractionated heparins. However, their effect on preventing blood clots is much easier to predict.

Also, when taking them, constant monitoring of the patient’s tests is not required, regardless of the dosage. The likelihood of developing side effects is significantly reduced.

All of the above allows the use of low molecular weight heparins as the main means for the treatment and prevention of thromboembolism. The drugs used in this group are: Nadroparin, Fragmin, Klekoane.

Prevention in the postoperative period

The likelihood of thromboembolism forming as a result of a surgical operation depends on the type of surgical intervention performed, its duration and other characteristics of the individual person’s body.

If the operation lasts less than thirty minutes with minor surgical exceptions from the body, the likelihood of blood clots is minimal.

During surgery malignant tumors in patients over the age of forty years, the risk of further blood clots increases significantly.

Unfractionated and low molecular weight heparin are used to prevent thromboembolism during surgical interventions. Unfractionated heparin is prescribed in small dosages two hours before surgery.

Subsequently, the drug is continued after twelve hours. Low molecular weight heparin is administered subcutaneously once a day. This use drugs can significantly reduce the risk of thromboembolism during general surgical interventions.

In some cases, long-term thromboembolic prophylaxis is required.

Among them:

• during cancer surgery;
• when prescribing chemotherapy;
• significant limitation in movement after surgery;
• when diagnosing significant risk factors in a patient.

In these cases, preventive measures continue for one month, and if necessary, extend the longest period.

Depending on the type of surgery undergone, there are a number of recommended preventive measures to prevent the development of thromboembolism.

During general surgical operations, preventive measures are prescribed based on observed risk factors. Among them:

• minimum possible outpatient treatment;
• use of elastic stockings;
• administration of low molecular weight heparin in small doses, with a duration of administration of up to four weeks every eight hours;
• course of variable pneumatic compression;
• unfractionated heparin.

For gynecological interventions:

• gradual increase in physical activity;
• use of non-drug methods of prevention;
• taking unfractionated heparin every eight hours.

After urological operations:

• early discharge and start of active life;
• low dosages of low molecular weight heparin;
• a course of health-improving physical education with a gradual increase in loads.

Neurosurgical interventions:

• use of unfractionated or low molecular weight heparin during postoperative rehabilitation;
• combined use of variable pneumatic compression and elastic stockings;
• increase in physical activity.

Conclusion

Prevention of thromboembolism begins with correctly determining the degree of risk of its development in the patient. Measures to prevent the formation of blood clots are recommended before any type of surgery.

According to statistics, in fifty percent of cases venous thrombosis begins to form at the time of the operation.

The greatest effectiveness among measures to prevent the development of thromboembolism is observed when combining medications and various compression measures.