Thrombo-prophylaxis in colorectal surgery: a National Questionnaire Survey of the members of the Association of Coloproctology of Great Britain and Ireland.

Aim: Available guidelines from the National Institute for Health and Clinical Excellence (NICE) and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) recommend combined (medical + mechanical) thrombo- prophylaxis. A Cochrane Library review recommends self-administered low-molecular-weight heparin (LMWH) for 2-3 weeks following surgery. In the light of the recent guidelines from the ACPGBI and NICE, we undertook a National Questionnaire Survey to assess current thrombo-prophylaxis practice among colorectal surgeons in the UK.

Method: A 10-item questionnaire was designed to enquire into the current management strategy of postoperative thrombo-prophylaxis. The postal questionnaire survey was sent to all 490 active consultant members of the ACPGBI.

Results: Of the 490 questionnaires sent, 259 (52.8%) were returned fully completed. Among these, all (100%) respondents reported the routine use of thrombo-prophylaxis, with 243 (93.8%) following departmental guidelines. Combined medical and mechanical prophylaxis was used by 247 (95.40%) respondents. A small number - 12 (4.6%) - used medical prophylaxis only. LMWH was the preferred medical-prophylactic agent of 243 (93.8%) repondents. The majority, 176 (68%), started thrombo-prophylaxis on admission and stopped it at discharge. Seventy-one (27.4%) respondents recommended thrombo-prophylaxis after hospital discharge for an average duration of 4-6 weeks, preferring graduated compression stockings followed by LMWH.

Conclusion: The National Questionnaire Survey on thrombo-prophylaxis demonstrated a high degree of concordance with the available guidelines, except for thrombo-prophylaxis to be continued postoperatively for a period of 28 days/4 weeks.