Arterial and venous thromboses are common serious postoperative complications (about 8% of surgical procedures are followed by a thrombosis). The fact that they are still so common despite years of research suggests we haven\u2019t yet cracked what causes them and how to prevent them. Although some risk factors like malignancy and previous thromboembolism are well established, others are less clear.<\/p>\n
A large observational study by Donz\u00e9 and colleagues<\/a> finds that patients with signs of systemic inflammation or sepsis in the preoperative period had a roughly threefold increased risk of postoperative arterial or venous thrombosis up to 30 days after surgery. The incidence ranged from 0.4% to 1.8%, depending on the patient subgroup. They also found a dose response effect, meaning that patients with more severe sepsis had an even greater risk of thrombosis.<\/p>\n In a linked editorial<\/a>, Paul Myles unpicks what the results mean for clinical practice. He says it\u2019s reasonable that patients with sepsis should be more intensively monitored and thromboprophylaxis guidelines fully implemented. However, because of the observational nature of the data he cautions against direct changes in practice until more definitive results from large randomised trials are available. And finally, the debate that continues to get everyone going is: \u201cShould patients be able to email their general practitioner?<\/a>\u201d\u00a0 The recent poll suggests the verdict is evenly split (47% yes, 53% no, at the time of writing). We\u2019ve had several more responses<\/a> to the article over the weekend, one of which is from Azeem Majeed, who has done his own audit of emails. Over the past year, he\u2019s had 84 email contacts with patients, only one of which was for a clinical query. He concludes that \u201cthe great majority of patients are aware that email is not a suitable medium for obtaining clinical advice.\u201d<\/p>\n Do send us your thoughts and experiences. Rapid responses can be submitted for every article in The BMJ<\/em>; some are published as formal letters to the editor.<\/p>\n <\/p>\n Giselle Jones<\/strong>\u00a0is specialist reviews editor, The BMJ.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":" Arterial and venous thromboses are common serious postoperative complications (about 8% of surgical procedures are followed by a thrombosis). The fact that they are still so common despite years of research suggests we haven\u2019t yet cracked what causes them and how to prevent them. Although some risk factors like malignancy and previous thromboembolism are well […]<\/p>\n
\nFor those of you who enjoy a diagnostic challenge, have a look at our Endgames quiz<\/a>.\u00a0 It illustrates the age old, saying that \u201ccommon things are common.\u201d But as the case shows, it doesn\u2019t necessarily follow that \u201ccommon things aren\u2019t missed.\u201d<\/p>\n