pharmaceutical therapy.
Data Collection
From January 1, 2019 to June 30, 2019 there were 570 surgical procedures at
our hospital. During the same period there were 198 prescribed enoxaparin.
One of these prescriptions was an OPD prescription and was excluded
because the patient chose conventional treatment over surgery. From the
570 surgical procedures, 197 (35%) of the patients received enoxaparin
post op.
The hospital’s guideline:
As per the hospital’s procedure for individual risk assessment and
prophylaxis recommendations (E.2):
a. At Pre assessment Clinic, The Medical Consultant will assess and
document on the “Venous Thromboembolism Risk Factor
Assessment and Prophylaxis Recommendations” form, which
includes the following:
i. The individuals VTE risk
ii. Any risk factors associated with increased risk of bleeding and
contraindications to pharmacological prophylaxis
iii. Any contraindications to mechanical prophylaxis
b. Balancing the risks of VTE and bleeding and appropriate VTE
prophylaxis recommended. VTE prophylaxis will not be offered if the
patient has any risk for bleeding and the risk of bleeding outweighs
the risk of VTE.
c. At conclusion of surgery, the operating surgeon will review the
recommendations of the Medical Consultant on the “Venous
Thromboembolism Risk Factor Assessment and Prophylaxis
Recommendations” form, and document the final recommendations
(based on preoperative recommendations and knowledge of
duration of surgery, complexity of surgery and anticipated period of
immobility) regarding pharmacological prophylaxis which includes:
i. Whether LMWH is to be commenced post operatively or not, and
if so:
1) Commencement time of LMWH (e.g.: 6, 12, 24 hours post op)
2) Duration of LMWH
ii. Whether concurrent use of NSAIDs for post-operative analgesia is
permitted
d. Upon patient return to the ward, the Medical Consultant will review
the surgeon’s final recommendations and prescribe
pharmacological prophylaxis accordingly.

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