Prophylaxis and Management of Deep Vein Thrombosis in Surgical Patients ‒ a Narrative Review

Abstract

Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), persists as a leading cause of preventable perioperative morbidity and mortality. Surgical patients are at variable and often substantial risk due to the synergistic effects of immobility, tissue injury, inflammation, and underlying comorbidities. Contemporary best practice is founded upon individualized risk assessment, the judicious application of pharmacological prophylaxis, primarily low-molecular-weight heparin (LMWH), and mechanical measures, coupled with a clear strategy for managing patients on chronic anticoagulation. For established VTE, direct oral anticoagulants (DOACs) have streamlined long-term management, though LMWH remains paramount in specific populations such as patients with cancer. This narrative review synthesizes current evidence and guidelines for the prevention and treatment of perioperative VTE, incorporating recent literature to inform clinical practice. Individualized prophylaxis guided by validated risk models and adherence to evidence-based protocols remains pivotal in reducing perioperative VTE morbidity and mortality.