With Scot Glasberg MD
Venus thromboembolism and potentially a pulmonary embolus is probably the scariest thing we as surgeons or physicians deal with, because things happen like that patient gets a PE and unfortunately could die from it very quickly. It’s the thing we really want to resist getting into so the best way to do that is through guidelines which set up a standard for assessing, who is at risk and then also assessing how to treat those patients. So the best thing that I use in my practice, which we put out to the members of the ASPS is something called the modified caprenous score. It takes into account the patient’s age, the length of the procedure, previous history of venous thromboembolism. Once we assess the score, it puts them into one of 3 categories, low, medium, and high risk and based on where they fall, we side whether we’re just going to use boots in the operating room, venodyne boots, or if they fall on the opposite side of the scale, chemoprophylaxis, or lovenox and what not.
When should Lovenox be used prophylactically?
There’s still some debate and controversy if you can use prophylaxis or when to start it. Some surgeons will start it preoperatively , and some surgeons like myself will start it 12 hours postoperatively, but I really think that it’s incredibly important for students to keep in mind that this is a very scary arena and it’s important for us to put the safety of our patients first and foremost. And this is something we absolutely cannot forget.