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high-effect methods make it the primary preventative measure for most
patients, certain patients undergoing certain surgeries may also benefit
from a dose of anti-coagulants. "Administering drugs is patient- and pro-
cedure-dependent," says Ms. Butler, "but the gold standard for high- and
even moderate-risk patients is an injection of low-molecular-weight
heparin."
Orally administered warfarin (Coumadin) or rivaroxaban (Xarelto)
are also available to prevent coagulation, but the medication route
must be followed with caution, particularly in the ambulatory setting.
"Anti-coagulant drugs don't prevent clots, they prevent blood from
being sticky," says Ms. Razzano. "Some surgeons don't want to give an
anti-coagulant before surgery because they don't want a bleeding situ-
ation." She cites sports medicine physicians who stand by pre-surgical
aspirin only, and only administer other anticoagulants to high-risk
patients as part of a combined compression-and-drugs approach.
The risk of DVT remains for as long as two weeks after surgery,
which is why post-op education is critically important among ambula-
tory patients, a population that might not see symptoms until well
after their same-day discharges.
Patients should know these signs. While DVT can occur even with-
out symptoms, the existence of pain, swelling, tenderness, discol-
oration, redness or warmth in the legs, ankles or feet are cause for
concern, as are chest pain or shortness of breath.
Patients should also be advised to stay hydrated and ambulate fre-
quently, avoiding prolonged sedentary behavior or lengthy travel dur-
ing their recoveries, says Ms. Razzano. "Promote and focus on ambu-
lation, but make sure they keep their stockings on," she says. OSM
E-mail
db ernard@outpatientsurg ery.net
.
D E E P - V E I N T H R O M B O S I S
Ophthalmic Surgery
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