Publication:

Risk profile and thromboprophylaxis practices among patients undergoing laparotomy at Moi teaching and referral hospital

Background Venous thromboembolism (VTE) significantly causes hospital mortality worldwide, with abdominal surgery a risk factor. Venous thromboprophylaxis can reduce VTE risk, but has adverse effects. Local research on risk profile and practice helps individualize thromboprophylaxis and develop local protocols.

Methods A prospective study was conducted at Moi teaching and referral hospital (MTRH) on adult laparotomy patients. The minimal sample size was 325 patients, using consecutive sampling. DVT was assessed using Well's score perioperatively, 2 weeks and 4 weeks postoperatively. A lower limb Doppler ultrasonography was performed on patients with a score of 2 or greater to rule out DVT.

Results The mean age of study participants was 38 years, with a 1.5:1 male-to-female ratio. Infection in the abdomen was the main reason for laparotomy. All procedures were open, and 75.4% of individuals had high or moderate VTE risk. Within 72 hours, 82.7% of patients were mobilized. Chemoprophylaxis was limited to enoxaparin post-op. Enoxaparin duration was unstandardized, and MTRH VTE risk categorization chart use was not reported. 3% of individuals received chemoprophylaxis against ACCP guidelines and 12% received enoxaparin despite contraindications. Only 13% and 24% of intermediate and high-risk patients got chemoprophylaxis. No mechanical prophylaxis was used. Symptomatic DVT was 6.8%. Advanced age, Caprini score, and enoxaparin prescription increased symptomatic DVT risk.

Conclusions Despite increased laparotomies for intra-abdominal infection and middle-aged patients, VTE is common in MTRH patients. Poor VTE risk stratification and MTRH protocol failure led to improper thromboprophylaxis. Prescribers should employ MTRH VTE regimen for proper prophylaxis. Providing prescribers with thromboprophylaxis choices to customize prescriptions.