Postoperative thrombosis prophylaxis
definition
At a postoperative thrombosis prophylaxis it concerns measures and medication that are used after an operation (= postoperative) to the risk of a thrombosis (Clotting of blood) to avoid. In the case of blood clots, it is particularly feared that the blood clot is transported further with the help of the blood (Embolus) and gets into the lungs, there Vessel blocked and then leads to the dreaded pulmonary embolism, which unfortunately in many cases fatal runs. That is why they are postoperative Thrombosis prophylaxis particularly important and should also be adhered to if prescribed. Thrombosis prophylaxis of this kind are particularly necessary after major operations and in patients with risk factors, i.e. factors that favor the development of a thrombosis.
Patients with risk factors / use of postoperative thrombosis prophylaxis
Not every patient needs one after an operation postoperative thrombosis prophylaxis. Postoperative thrombosis prophylaxis is unnecessary, especially after minor operations, such as those performed laparoscopically, as is the case with small children or with patients who return very quickly mobilized be able to move again very quickly after the operation and no longer lie in bed. However, there are many risk factors that make the use of postoperative thrombosis prophylaxis absolutely necessary. These include patients in whom there are frequent cases of thrombosis in the family, Heart attacks (Myocardial infarction) or Strokes (Apoplexy) appeared. This also includes young women who oral contraceptives ("The pill") take and / or smoke and / or about 35 years old are (see: Thrombosis risk of the pill). In general, women are more at risk of thrombosis than men. Another risk factor is very overweight (Obesity). Also can Dehydration cause the blood to become more viscous, which then favors the formation of a blood clot, i.e. a thrombus. It is therefore particularly important to drink a lot after major operations. Also Cancers and above all one pregnancy are considered risk factors for the development of a postoperative thrombosis. It is therefore particularly important to carry out postoperative thrombosis prophylaxis after a major operation with a long hospital stay.
Non-drug postoperative thrombosis prophylaxis
Lie one or multiple risk factors before, the patient should undertake thrombosis prophylaxis postoperatively.
Depending on how many risk factors are present and how serious they are, you can initially only apply non-drug agents can be used. Especially with young patientsThose who, for example, have had a broken leg, but are otherwise fit, usually receive non-drug postoperative thrombosis prophylaxis. These include on the one hand that the patient drink enough must so that the blood remains thin and thus the formation of a thrombus is counteracted. Additionally, the patient should try to get their legs back in as early as possible Move get.
If the patient cannot walk yet, one should physical therapy operated as a thrombus mainly in the deep leg veins arises and this mainly through the movement of the legs and the resulting Muscle contraction can be avoided. This then leads to faster blood flow in the veins, which in turn counteracts the formation of the thrombus.
Exercise, when possible, is one of the best post-operative thromboprophylaxis. However, since this is not possible for many patients after a major operation, many patients use the so-called Support stockings or Compression stockings. Also Compression bandages can be created. This is extreme tight-fitting stockingswhich the patient can wear day and night or only at night. Since the support stockings are so extremely tight, it comes to one Squeeze (compression) of the leg, so that the leg becomes much narrower in the support stocking because everything is pressed together. This also means that the venous blood vessels that transport the blood from the feet back towards the abdomen are also narrowed. This narrowing now causes the Blood faster flows through the venous blood vessels and don't clump together can. It is important that the compression stocking has one in the area of the foot and lower leg bigger pressure builds up than in the area of the thigh, so that the blood can flow more easily towards the abdomen.
Today, the use of such support stockings is viewed more and more critically, as they hardly have any effect, especially on immobile patients, i.e. patients lying in bed. Nevertheless, support stockings are extremely popular in most hospitals postoperative thrombosis prophylaxis although it actually makes the most sense if the patient is able to move the legs, which are in the support stocking, at least a little, i.e. to walk at least a few steps.
Drug-based postoperative thrombosis prophylaxis
It makes sense to use drug-based postoperative thrombosis prophylaxis, particularly in older patients who can no longer be mobilized or in patients who have several risk factors. In this context, drugs are mainly used that inhibit blood clotting and thus ensure that the blood platelets (Platelets) do not stick together and form a thrombus.
These anticoagulants are called in medical terminology Anticoagulants. Heparinoids, i.e. drugs that are derived from heparin or imitate the effect of heparin, are used particularly frequently. Heparin is normally produced in the liver in humans and physiologically inhibits blood clotting. If you now give heparinoids, i.e. heparin analogues, the blood is thinned, which is very useful as a medicinal postoperative thrombosis prophylaxis.
Also comes into question Acetylsalicylic acid or aspirin. Especially after heart attacks, it is often used as a long-term medication, but it is not as suitable as a postoperative thrombosis prophylaxis as, for example, factor Xa inhibitors. Factor Xa is important to complete clotting. If you now inhibit this factor, no clotting takes place and the blood remains thin and does not clump into a thrombus. One differentiates between direct Factor Xa inhibitors (for example Xarelto®Rivaroxaban, abixaban) and indirect Factor Xa inhibitors, which are the heparin analogues already mentioned (for example Danaparoid). The direct factor X-a inhibitors are among the new anticoagulants and are now used more frequently in postoperative thrombosis prophylaxis.
Over a longer period of time, sometimes as a long-term medication, the derivatives of the coumarins (Warfarin) or the phenprocoumon (Marcumar) can be used. These inhibit vitamin K. Vitamin K is normally responsible for clotting, so it helps to create a clot of blood, which is extremely important for a fresh wound, for example. If the vitamin K is now inhibited, it can no longer develop its effect and the blood liquefies, which is excellent for postoperative thrombosis prophylaxis, but has a very negative effect on wound healing. This in turn means that patients who take vitamin K inhibitors bleed heavily and, above all, for much longer when injured.
