[Risk management and medical safety under surgery; plumonary thromboembolism].

It was reported that pulmonary embolism rarely occurs in Japan, and physicians did not think about the prevention of venous thromboembolism until about 20 years ago. Recently, however, it has been reported that pulmonary embolisms are on the increase in Japan. The Japanese prophylactic practice guidelines were published in February 2004, and subsequently the prevention of pulmonary embolisms and deep vein thrombosis has gradually become widespread, generally using mechanical prevention. However, the most effective measure to prevent venous thromboembolism is early ambulation and active exercise, while the administration of an anticoagulant is the most effective to prevent fatal and symptomatic pulmonary embolism. However, anticoagulant therapy is associated with complications such as hemorrhage and heparin-induced thrombocytopenia. Therefore, it is important for individual medical institutions to develop in-house manuals on the prevention of venous thrombosis and the bases for the selection of mechanical prevention, anticoagulant therapy, or ambulation/exercise. The number of patients with venous thromboembolism (secondary prevention) requiring treatment before undergoing surgery has also increased recently. It is important for hospitals to cooperate to solve problems, such as by undertaking medical safe national joint action, in a specific clinical area instead of simply undertaking risk management in the prophylaxis of thrombosis in single institutions.