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Each year, surgeons in the United States perform more than 46 million inpatient surgeries, the majority of which are nonorthopedic surgeries. Patients undergoing nonorthopedic surgeries are a heterogeneous group in terms of surgery type, comorbidities, and associated risk for venous thromboembolism (VTE), which comprises deep vein thrombosis (DVT) and pulmonary embolism (PE). Patients at low risk for VTE typically undergo surgical procedures lasting less than 30 minutes, are immediately mobile following surgery, or are already receiving therapeutic-dose anticoagulant therapy. All other surgical patients are considered to be at moderate or higher risk for VTE and merit some form of prophylaxis. VTE in the patient undergoing nonorthopedic surgery can cause significant morbidity and mortality and is a common cause of readmission to the hospital.
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Many factors contribute to VTE after nonorthopedic surgery (Table 58-1).
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Trauma and surgery both contribute to venous injury and activation of the coagulation system. Postoperatively, patients may have persistently reduced mobility, which causes stasis of blood flow in the deep venous system. Patients undergoing certain types of surgery may also have independent risk factors for VTE, such as obesity in the bariatric surgical patient.
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As in the orthopedic surgery setting, most episodes of postoperative DVT in nonorthopedic surgery are clinically silent. These unnoticed clots usually resolve spontaneously without administration of antithrombotic therapy. However, 25% to 50% grow and cause symptomatic DVT or PE.
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Does This Patient Undergoing General Surgery Need VTE Prophylaxis?
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