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PubMed1999

Educational campaign to improve the prevention of postoperative venous thromboembolism.

BACKGROUND: Recent studies have revealed considerable scope for improvement in preventing postoperative venous thromboembolism. This project comprised a baseline assessment of the use of preventive measures within the Royal Hobart Hospital, followed by the implementation and evaluation of an educational program directed at hospital staff. AIM: To determine whether the Royal Hobart Hospital's guidelines for the prophylaxis of postoperative venous thromboembolism were being utilized effectively and, if necessary, attempt to improve use of the guidelines through an educational programme. METHODS: Data were collected retrospectively from the medical records of 250 surgical patients undergoing a procedure during February 1997. Patients were classified as being at a low, medium or high risk of venous thromboembolism using two sets of criteria. The percentage of patients receiving the appropriate prophylaxis was determined. An educational programme to promote the hospital's guidelines for the prophylaxis of postoperative venous thromboembolism was then implemented. Included were presentations to staff, posters placed throughout the hospital and the wide distribution of the results and a glossy card showing the hospital's guidelines. Follow-up data were subsequently collected from another 250 surgical patients. RESULTS: Only 59% of patients received appropriate prophylaxis according to the hospital's approved guidelines, with little change when those patients with possible contraindications to thromboprophylaxis were excluded. When those patients at a high risk of venous thromboembolism were examined, only 25% were prescribed the recommended preventive measures. There was no difference between elective versus emergency surgery and the use of appropriate prophylaxis. Following the implementation of the educational programme, data collection from another 250 surgical patients revealed a significant increase (P < 0.05 by chi-square test) in the level of appropriate thromboprophylaxis to 70% of patients, with 77% of the high-risk patients being prescribed the recommended preventive measures. CONCLUSIONS: A pharmacy-based educational intervention significantly improved adherence to the hospital's guidelines for the prophylaxis of postoperative venous thromboembolism.

Australia↗
PubMed2003

Incidence of cancer after a first episode of idiopathic venous thromboembolism treated with 3 months or 1 year of oral anticoagulation.

BACKGROUND: A prolonged treatment with oral anticoagulants has been claimed to reduce the incidence of newly diagnosed cancer in the long-term follow-up of patients with venous thromboembolism. OBJECTIVES: In a multicenter prospective study we assessed the incidence of newly diagnosed clinically overt cancer in patients with a first episode of idiopathic venous thromboembolism (VTE) treated with oral anticoagulants for 3 months or 1 year. PATIENTS AND METHODS: Consecutive patients with an idiopathic venous thromboembolism who had completed 3 months of oral anticoagulant therapy without having a recurrence, bleeding or newly diagnosed cancer were randomized to discontinue oral anticoagulant therapy or to continue it for nine additional months. Idiopathic venous thromboembolism was defined as thrombosis occurring in the absence of known cancer, known thrombophilia, or temporary risk factors for venous thromboembolism. All patients were followed up for at least 1 year after randomization. RESULTS: A total of 429 patients, 265 patients with DVT and 164 with PE, were followed up for an average of 43.7 months after randomization. A newly diagnosed cancer occurred in 32 patients (7.5%), 13 (6.2%) of the 210 patients treated for 3 months and 19 (8.7%) of the 219 patients treated for 1 year (RR = 0.71, 95% confidence interval 0.36-1.41). CONCLUSIONS: The incidence of newly diagnosed clinically overt cancer is not reduced in patients with idiopathic venous thromboembolism treated with 1-year anticoagulant treatment compared with patients treated for 3 months.

Administration, Oral↗
PubMed2000

[Practice of perioperative thromboembolic prophylaxis in neurosurgery: results of a German survey].

Many neurosurgical patients are at high risk of developing thromboembolic disease. Although recent data support the benefit of pharmacological thromboembolic prophylaxis, the optimal starting point for the different neurosurgical procedures remains unclear because the potentially devastating consequences of intracranial or intraspinal haemorrhage could easily offset the reduction in thromboembolic morbidity and mortality resulting from pharmacological thromboembolic prophylaxis. The objective of our study was to assess the use of pharmacological methods of thromboembolic prophylaxis in contemporary German neurosurgery using a postal survey in 34 neurosurgical departments. Low-dose heparin or low molecular weight heparin (LMWH) were used in 88% to 97% of neurosurgical units participating in our survey. In craniotomies, in 2 units (6%) heparin or LMWH was routinely started before surgery, in 10 units (29%) < 8 hours after surgery, in 15 units (44%) < 24 hours after surgery, in one unit at the second day and in 5 units at the third day after surgery. Data for burr hole craniotomy or spinal surgery were similar. In our survey a high rate of perioperative use of pharmacological thromboembolic prophylaxis was found. However, given the data from the literature, the optimum protocol remains unclear.

Anticoagulants↗
PubMed1999

A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism.

BACKGROUND: Patients who have a first episode of venous thromboembolism in the absence of known risk factors for thrombosis (idiopathic thrombosis) are often treated with anticoagulant therapy for three months. Such patients may benefit from longer treatment, however, because they appear to have an increased risk of recurrence after anticoagulant therapy is stopped. METHODS: In this double-blind study, we randomly assigned patients who had completed 3 months of anticoagulant therapy for a first episode of idiopathic venous thromboembolism to continue receiving warfarin, with the dose adjusted to achieve an international normalized ratio of 2.0 to 3.0, or to receive placebo for a further 24 months. Our goal was to determine the effects of extended anticoagulant therapy on rates of recurrent symptomatic venous thromboembolism and bleeding. RESULTS: A prespecified interim analysis of efficacy led to the early termination of the trial after 162 patients had been enrolled and followed for an average of 10 months. Of 83 patients assigned to continue to receive placebo, 17 had a recurrent episode of venous thromboembolism (27.4 percent per patient-year), as compared with 1 of 79 patients assigned to receive warfarin (1.3 percent per patient-year, P<0.001). Warfarin resulted in a 95 percent reduction in the risk of recurrent venous thromboembolism (95 percent confidence interval, 63 to 99 percent). Three patients assigned to the warfarin group had nonfatal major bleeding (two had gastrointestinal bleeding and one genitourinary bleeding), as compared with none of those assigned to the placebo group (3.8 vs. 0 percent per patient-year, P=0.09). CONCLUSIONS: Patients with a first episode of idiopathic venous thromboembolism should be treated with anticoagulant agents for longer than three months.

Anticoagulants↗
PubMed2000

Incidence of cancer after prophylaxis with warfarin against recurrent venous thromboembolism. Duration of Anticoagulation Trial.

BACKGROUND: The length of time after an episode of venous thromboembolism during which the risk of newly diagnosed cancer is increased is not known, and whether vitamin K antagonists have an antineoplastic effect is controversial. METHODS: In a prospective, randomized study of the duration of oral anticoagulation (six weeks or six months) after a first episode of venous thromboembolism, patients were questioned annually about any newly diagnosed cancer. After a mean follow-up of 8.1 years, we used the Swedish Cancer Registry to identify all diagnoses of cancer and causes of death in the study population. The observed numbers of cases of cancer were compared with expected numbers based on national incidence rates, and the standardized incidence ratios were calculated. RESULTS: A first cancer was diagnosed in 111 of 854 patients (13.0 percent) during follow-up. The standardized incidence ratio for newly diagnosed cancer was 3.4 (95 percent confidence interval, 2.2 to 4.6) during the first year after the thromboembolic event and remained between 1.3 and 2.2 for the following five years. Cancer was diagnosed in 66 of 419 patients (15.8 percent) who were treated for six weeks with oral anticoagulants, as compared with 45 of 435 patients (10.3 percent) who were treated for six months (odds ratio, 1.6; 95 percent confidence interval, 1.1 to 2.4). The difference was mainly due to the occurrence of new urogenital cancers, of which there were 28 cases in the six-week group (6.7 percent) and 12 cases in the six-month group (2.8 percent) (odds ratio, 2.5; 95 percent confidence interval, 1.3 to 5.0). The difference in the incidence of cancer between the treatment groups became evident only after two years of follow-up, and it remained significant after adjustment for sex, age, and whether the thromboembolism was idiopathic or nonidiopathic. Older age at the time of the venous thrombosis and an idiopathic thromboembolism were also independent risk factors for a diagnosis of cancer. No difference in the incidence of cancer-related deaths was detected. CONCLUSIONS: The risk of newly diagnosed cancer after a first episode of venous thromboembolism is elevated during at least the following two years. Subsequently, the risk seems to be lower among patients treated with oral anticoagulants for six months than among those treated for six weeks.

Administration, Oral↗
PubMed2002

Thromboembolism in patients on thalidomide for myeloma.

Seven cases of thromboembolism were found amongst 23 patients treated with thalidomide for myeloma over a total of 141.5 patient treatment months. Five thromboembolic events were venous (two severe) and two arterial. A historical control of 18 similar patients not given thalidomide had one thromboembolism over 289 months. We found no underlying thrombophilic tendency in the affected patients. We suggest that the thalidomide may predispose to thromboembolism at even lower doses than previously reported (mean dose 150 mg). The two most severe thromboses occurred on 100 mg thalidomide alone, not associated with chemotherapy or glucocorticoids. We raise the possibility that arterial thromboembolism may also occur in association with thalidomide. Some patients continued thalidomide after the event, together with warfarin, with no further thromboembolism.

Aged↗
PubMed2001

Evolution of cerebral ischaemia induced by thromboembolism in rats detected by early sequential MR imaging.

Thromboembolic stroke appears to evolve in patients in a very complicated manner. The present study investigated the evolution of thromboembolic stroke in rats (n=9) using a 4.7-T MR imager. Under isoflurane anaesthesia, the rats received homologous blood clots into the right internal carotid artery. After thromboembolic stroke, lesion volume, which was defined and calculated, based on apparent diffusion coefficient maps, tended to increase gradually over the 6 h magnetic resonance imaging study. The largest percentage change in lesion volume was found at the early stage (40-100 min) of thromboembolism, and showed significant correlation with total percentage change in lesion volume (41.6 (SD 32.8%)) (r=0.77, P<0.05). In conclusion, marked enlargement or diminution of lesion volume may be observed at the early stage of thromboembolism. Thromboembolic stroke, which can be partly salvaged at the early stage, may likely evolve to a lesser extent thereafter.

Animals↗
PubMed1984

Factors influencing thromboembolic complications in Omniscience cardiac valve patients.

Clinical data were gathered over five years (650 patient-years) for all 155 aortic valve replacement, 125 mitral valve replacement and 46 double valve replacement patients implanted with the Omniscience cardiac valve prosthesis at three North American medical cent es. Mean age was 56 +/- 12 years, 80% were preoperatively in NYHA class III or IV, and 57% had previous or concomitant cardiac surgery. Data were evaluated for the incidence of thromboembolic complications. During the late postoperative period, transient ischaemic episodes occurred in six patients (0.92% per patient-year). The five-year actuarial thrombus-free rate for serious thromboembolic complications (valve thrombosis or thromboembolism with residual effects) for aortic valve replacement patients is 96% and 95% for mitral valve replacement patients. For patients experiencing any transient or serious thromboembolic complication, 35% had a compromise of coumadin anticoagulation shortly before the thromboembolic event, 60% had a history of atrial fibrillation, and 76% a history of rheumatic heart disease. Statistically, these rates are significantly higher compared with the original valve population. The low incidence of thromboembolic complications over this five-year clinical study demonstrates a commendable degree of safety and performance for the Omniscience valve.

Actuarial Analysis↗
PubMed2003

Is treatment of atrial fibrillation in primary care based on thromboembolic risk assessment?

BACKGROUND: Antithrombotic treatment in atrial fibrillation should be guided by the risk of thromboembolic events. Although practice studies have shown underutilization of antithrombotics, it is not clear whether physicians make use of thromboembolic risk stratification in their treatment decisions, as recommended in current guidelines. OBJECTIVE: The aim of the present study was to assess which clinical determinants influence coumarin and aspirin prescription in patients with atrial fibrillation in primary care. METHODS: In a cross-sectional study of 15 computerized general practices covering 38 000 patients in The Netherlands, we identified patients with atrial fibrillation using several search algorithms. Determinants of antithrombotic therapy were assessed using polytomous logistic regression analysis. RESULTS: A total of 247 patients with atrial fibrillation were identified among 10 335 patients aged 55 years or over (prevalence 2.4%). Mean age was 77 years (range 55-95); 51% were male. Overall, 52% of the patients used coumarin and 27% used aspirin. About 50% of patients were also treated by a cardiologist. Referred patients were prescribed coumarin more often (63% versus 35%, P < 0.001). Prior stroke/transient ischaemic attack or systemic embolism [adjusted odds ratio (OR) 5.3, 95% confidence interval (CI) 1.1-24.8], and chronic heart failure (adjusted OR 2.1, 95% CI 0.8-5.1) were independent determinants for coumarin prescription. These associations were less strong for aspirin prescription. However, other established risk factors for future thromboembolic events, such as hypertension and diabetes mellitus, did not lead to higher prescription rates. In contrast, several factors not associated with thromboembolic events, such as chronic (versus paroxysmal) atrial fibrillation (adjusted OR 3.7, 95% CI 1.7-8.2) and longstanding (versus recent) diagnosis (adjusted OR 2.2, 95% CI 1.1-4.5), were also associated with higher coumarin prescription. CONCLUSION: These results illustrate that physicians' decisions about initiating antithrombotic therapy in atrial fibrillation are not evidence based. They are guided partly by thromboembolic risk stratification, but also by factors insignificant for thromboembolic risk.

Aged↗
PubMed1996

Systemic thromboembolism in chronic heart failure. A prospective study in 406 patients.

In patients with heart failure the risk of systemic thrombo-embolism and the benefit of anticoagulation are uncertain. To assess the incidence of systemic thromboembolism and the factors associated with an increased risk, 406 consecutive patients with chronic heart failure were prospectively investigated. Their left ventricular ejection fraction was 23 +/- 8%, pulmonary wedge pressure 19 +/- 10 mmHg and cardiac index 2.3 +/- 1.41. min-1.m-2 of body surface area. Two hundred patients were in NYHA functional class III-IV. Two hundred and thirty-two patients were receiving oral anticoagulants. Over a follow-up period of 16 +/- 11 months, thromboembolism occurred in 11 patients (2.7%), seven of whom were on anticoagulants. Among clinical, echocardiographic and haemodynamic variables, atrial fibrillation, more severe haemodynamic impairment and low exercise capacity were associated with increased thromboembolic risk. No echocardiographic findings, including the presence of intracavitary thrombi, either at baseline or during follow-up, were related to subsequent thromboembolic events. The rate of embolism did not differ in patients receiving anticoagulants (4%) compared with those who did not receive anticoagulants (1%). No major bleeding occurred during follow-up. Thus, in patients with chronic heart failure and sinus rhythm the incidence of systemic thromboembolism is low regardless of anticoagulant treatment. Atrial fibrillation, particularly when associated with low cardiac index, identifies a subgroup of patients at high risk of events. In this subgroup, a moderate-intensity anticoagulant regimen provides unsatisfactory protection against thromboembolism.

Adult↗
PubMed2003

Thromboembolic complications related to indwelling central venous catheters in children.

PURPOSE OF REVIEW: Thrombosis is one of the most frequent complications of indwelling central venous catheters. During the past year, new information has emerged regarding the incidence and predisposing factors of thromboembolic complications of indwelling central venous catheters. Because indwelling central venous catheters are widely used, it is important to be aware of new information regarding thromboembolic complications of these devices. RECENT FINDINGS: Recent studies have better defined the risks of thromboembolic complications in patients with cancer with indwelling central venous catheters. Acquired hypercoagulable disorders such as heparin-induced thrombocytopenia, antiphospholipid syndrome, and therapy with asparaginase are associated with thromboembolic disorders in patients with indwelling central venous catheters. Studies analyzing the association between inherited hypercoagulable disorders and thrombosis have shown conflicting results. Preliminary studies suggest that low molecular weight heparins could have a role in the prevention of catheter-related thromboembolic disorders. Nevertheless, larger prospective studies will be necessary to determine the role of anticoagulants in the prevention of thromboembolic disorders in patients with cancer with indwelling central venous catheters. SUMMARY: Recent reports will facilitate the evaluation and risk assessment of children with cancer who have indwelling central venous catheters. Despite these advances, large, controlled studies focusing on specific populations of patients, such as children, should be undertaken to determine the true performance and optimal use of indwelling central venous catheters. Future studies should also address better ways to prevent catheter-related thrombosis and infection.

Catheterization, Central Venous↗
PubMed1999

Lack of association between factor V Leiden and thromboembolism in patients with prosthetic heart valves.

Thromboembolism represents the most serious complication in patients with prosthetic heart valves, and causes significant mortality and morbidity. Many risk factors for the condition have been identified. However, many patients who have a therapeutic level of anticoagulation and no obvious risk factors develop thromboembolism. Factor V Leiden, found in 3-7% of the normal population, is the most common inherited factor associated with thrombosis. Whether or not this factor is associated with thromboembolism in this setting has not been explored. This study compares the prevalence of factor V Leiden in patients with prosthetic heart valves, with and without thromboembolic complications. A total of 148 patients were studied. Thirty had documented thromboembolic complications and none exhibited the factor V mutation. Of the 118 patients without thromboembolic complications, seven (5.9%) were heterozygous for factor V Leiden (P = 0.345, by Fisher's two-tailed exact test; odds ratio 0, 95% confidence interval 0.0-4.34). We conclude that until future data shows otherwise, routine testing for factor V Leiden in patients with prosthetic heart valves is not warranted, except as part of ongoing research.

Bioprosthesis↗
PubMedDate not supplied

Device induced thromboembolism in a bovine in vitro coronary stent model.

The potential of a new bovine in vitro model to evaluate various aspects of device induced thromboembolism was studied using two test modes. First, the effect of an antithrombotic drug on stent induced thromboembolism was assessed. The antithrombotic potential of an antiplatelet agent was compared with that of the other conventional antithrombotic agents (aspirin, dipyridamole) used in the past with this in vitro model. Stent associated thrombus was assessed gravimetrically at the end of the experiment. Emboli were assessed continuously using a light scattering microemboli detection system. Second, the sensitivity of the model to flow induced thromboembolism was studied using a combination of surface roughness and stenosis. Thrombus was assessed visually, and emboli were assessed as described earlier. The results show that 1) this in vitro model is sensitive to the action of antithrombotic drugs, and to the effect of hemodynamics on thromboembolism; 2) the antiplatelet drug used in this study was effective in attenuating thromboembolism; 3) a stenosis in combination with roughness produced more emboli than roughness alone; and 4) the model was useful for the study of physical and biochemical aspects of thromboembolism.

Animals↗
PubMed2003

Venous thromboembolism in laparoscopic surgery.

Currently there are limited randomized data regarding thromboprophylaxis in laparoscopic surgery. The aim of this article is to identify principles to guide safe practice with regard to prevention of venous thromboembolism. With the exception of laparoscopic cholecystectomy, there are no prospective, randomized studies comparing the incidence of venous thromboembolism between a conventional procedure and a laparoscopic procedure for the same operation. Surveys of surgical practice indicate that policies for venous thromboembolism prophylaxis in laparoscopic surgery are generally the same as those for conventional surgery. The increasing use of a minimal access approach for a variety of abdominal, pelvic, and thoracic procedures demands further prospective, randomized studies in this area. Current guidelines endorsed by The Society of American Gastrointestinal Endoscopic Surgeons recommend following the adoption of protocols used in conventional surgery for the equivalent laparoscopic operation, and the European Association for Endoscopic Surgery has recommended the use of intraoperative intermittent pneumatic compression of the lower extremities for all prolonged laparoscopic procedures. There is only limited evidence to support these recommendations. Venous thromboembolism is an important and preventable complication in surgical patients. Evidence does not exist to consider laparoscopic surgery patients to be at a substantially lower risk for venous thromboembolism than those undergoing conventional procedures. Currently there is a lack of data regarding the prophylaxis against venous thromboembolism in laparoscopic surgery, and the practice is thus opinion based. The authors recommend that the use of standard prophylactic regimens tailored to specific patient populations for conventional operations be adopted for laparoscopic surgery until prospective data are available.

Humans↗
PubMed2003

Olanzapine and venous thromboembolism.

Clozapine has recently been associated with venous thromboembolism. The aim of this study was to describe three elderly patients in whom olanzapine therapy was associated with venous thromboembolism. During a 4-month period at the same psychogeriatric clinic, three elderly patients (an 89-year-old male, a 78-year-old male and an 83-year-old female) developed deep venous thrombosis shortly after treatment with olanzapine was initiated. Two of the patients also had symptoms consistent with a diagnosis of pulmonary embolism. None had previously been diagnosed with venous thromboembolism. These cases indicate that venous thromboembolism might be associated with the use of olanzapine, at least in geriatric patients. Subjects treated with olanzapine should be monitored clinically for venous thromboembolism to ensure early detection and prompt intervention, and a possible discontinuation of treatment with olanzapine should be considered after a diagnosis of venous thromboembolism.

Aged↗
PubMed2006

A prospective observational study of a cohort of outpatients with an acute medical event and reduced mobility: incidence of symptomatic thromboembolism and description of thromboprophylaxis practices.

OBJECTIVES: The study was performed to determine the incidence of symptomatic venous thromboembolism in outpatients with an acute medical event causing temporary reduced mobility. Risk factors for venous thromboembolism and thromboprophylaxis practices were also studied. DESIGN: This was a prospective, observational, multicentre, cohort study. SETTING: General practitioners randomly selected from a registry of 25,000 active representative doctors in France including eligible outpatients. SUBJECTS: Outpatients aged at least 40 years anticipated to have reduced mobility for at least 48 h due to an acute medical event were eligible. INTERVENTIONS: None required. MAIN OUTCOME MEASURES: Symptomatic deep-vein thrombosis and pulmonary embolism at 3 weeks were the main study end-points. RESULTS: Overall, 16,532 evaluable patients of mean age 71 years were recruited between October 2002 and June 2003 by 2895 doctors. The main acute medical events leading to reduced mobility were infection, acute rheumatism and falls without fracture. The incidence rates (95% confidence interval) of symptomatic deep-vein thrombosis and pulmonary embolism were 1% (0.84-1.14) and 0.20% (0.13-0.27) respectively. Venous insufficiency in legs, cancer, and a personal or family history of venous thromboembolism were independent risk factors for venous thromboembolism. Pharmacological thromboprophylaxis was initiated in 35.0% (n=5782) of the patients. The principal driver of prescription was a personal history of venous thromboembolism. CONCLUSIONS: The risk of symptomatic venous thromboembolism in outpatients with reduced mobility for medical reasons is close to that reported in medical and surgical inpatients. This risk and the potential need for thromboprophylaxis should be taken into account by primary care doctors.

Acute Disease↗
PubMed2006

Risk of thromboembolism after cerebral venous thrombosis.

The outcome of cerebral venous thrombosis (CVT) has been studied infrequently. We assessed the frequency of recurrence of cerebral or systemic thromboembolism and factors influencing recurrence. We performed a retrospective study of consecutive patients with CVT in the period 1985-2002 who were admitted to the University Hospital Gasthuisberg. We performed a chart review and a semi-standardized telephone interview that focused on recurrent CVT or systemic thromboembolism. Fifty-four CVT patients with a mean age of 42 years were followed up for a mean of 3.5 years. Eighty percent were women. Coagulation disorders were found in 17 patients (31%). One patient (1.9%) had recurrent CVT and seven patients (12.9%) suffered systemic thromboembolism after a median of 2.5 months. Patients with recurrent thromboembolism more often had coagulopathies (P = 0.04) or a history of deep venous thrombosis (P = 0.007). Patients with early recurrent venous thromboembolism often were not treated with oral anticoagulants (P < 0.001). It was evident from the above study that a substantial number of patients suffer recurrent thromboembolism after CVT.

Adult↗
PubMed1991

Incidence of venous thromboembolism verified by necropsy over 30 years.

OBJECTIVE: To determine the incidence of venous thromboembolism in all necropsy reports over 30 years. DESIGN: Study of all necropsies in one hospital in 1987 and longitudinal analysis of results of necropsy in 1957, 1964, 1975, and 1987. SETTING: Departments of general surgery, infectious diseases, internal medicine, oncology, and orthopaedics in a Swedish general hospital. MAIN OUTCOME MEASURE: Number of cases of venous thromboembolism. RESULTS: About a third of all necropsies showed venous thromboembolism. In 1987, 260 of 347 necropsies showing venous thromboembolism found pulmonary embolism, of which 93 were classified as fatal, 90 as contributory, and 77 as incidental. Only 21 contributory or fatal postoperative pulmonary emboli were seen. In only 106 of 260 patients with pulmonary embolism did routine necropsy not show the source of embolism. Calf veins were not routinely examined. Deep venous thrombosis was seen in 239 patients in 1987. The incidence of venous thromboembolism in the four years studied was remarkably stable except in the department of orthopaedics, where the proportion fell from 60.7% in 1975 to 32.2% in 1987 (p less than 0.05), although there were only a few patients. CONCLUSIONS: The overall incidence of venous thromboembolism has not changed over 30 years. During this period the proportion of the population aged over 65 has doubled, and this may have masked the beneficial effects of prophylaxis and early mobilisation. Prevalences corrected for age are needed.

Aged↗