Assessment of subclinical deep vein thrombosis in post laparotomy patients

Background: DVT, in post surgical patients, is less prevalent among the Indians and Asians, varying from 1.3% in spinal surgery to 41.7% following colorectal surgery. The majority of the patients developing post-operative DVT are subclinical and asymptomatic. Subclinical DVT means presence of thrombus (semi-solid coagulum) in deep veins of lower limb without any signs and symptoms. DVT can be prevented more successfully in its subclinical phase than that in its clinical phase. Aim: The present study “Assessment Of Subclinical Deep Vein Thrombosis In Post Laparotomy Patients” was undertaken to estimate the occurrence and associated risk factors of subclinical deep vein thrombosis at our institute after exploratory laparotomy in both elective and emergency surgeries. Methods: This is a prospective study of 175 patients who underwent exploratory laparotomy, for acute or chronic conditions, and includes both elective and emergency cases. Patients of age<18 years, haematological disorders, on anticoagulant treatment including aspirin, having history of Myocardial Infarction, Congestive heart failure, pregnancy and postpartum, intake of oral contraceptives or Hormone Replacement Therapy, and duration of surgery <1 hour 30 minutes were excluded. On 5th and 10th postoperative days, duplex venous ultrasound of bilateral lower limbs were performed in every patients to look for presence of thrombus in the deep veins. Results: Out of 175 patients, 3 (1.714%) developed subclinical deep vein thrombosis. Incidence was maximum in the age group 51-70 years (5.88 %). The incidence of subclinical DVT was found to be more in females (4.08)% as compared to males (0.79 %). The incidence was maximum in patients undergoing surgery for duration longer than 5 hours (25%) leading to longer periods of immobilization. Among the various pathologies, incidence was more in patients of malignancies (11.76 %). Conclusion: It can be concluded that incidence of subclinical deep vein thrombosis is very low in the post operative period among the Indian population undergoing major abdominal surgeries. However, patients of old age, those with duration of surgery longer than five hours, those with malignancies and those with longer periods of immobilization need anticoagulant prophylaxis. It has also been found that VTE, if develops, is maximum between 5th and 10th postoperative period depending upon various compounding factors and is easily cured by giving LMWH (Low Molecular Weight Heparin). Thus routine prophylaxis against DVT with anticoagulants is not warranted in patients with moderate risk undergoing major abdominal surgery in Indian scenario.