Venous thromboembolic disease in the older surgical patient, part II: Diagnosis and management

Older adults undergoing major surgical procedures are at high risk for developing deep vein thrombosis (DVT) and pulmonary embolism (PE). Part I of this article reviewed the prophylaxis of DVT and PE in older surgical patients. Part II will discuss the diagnosis and management of these conditions in the peri-operative setting. Despite implementation of effective prophylactic measures, DVT occurs in up to 20% of patients and PE occurs in up to 10% of patients undergoing major surgery. Close vigilance is therefore required to avoid overlooking these potentially serious complications. Once a diagnosis of DVT or PE has been established, treatment consists of intravenous unfractionated heparin or subcutaneous LMWH followed by warfarin for a minimum of 6-12 months. With optimal prophyaxis and prompt diagnosis and treatment, the risk of serious venous thromboembolic complications in older persons requiring major surgery is acceptably low.