Thromboembolism

This is a unique question-and-answer chapter for surgical residents and trainees, concentrating on thromboembolism. Prophylactic and therapeutic anticoagulation in patients with nonoperatively managed solid organ injuries is a controversial topic with a paucity of data to support any opinion. The hypercoagulability of pregnancy is an evolutionary response to protect women from exsanguination during childbirth. Indeed, hemorrhage is still the leading cause of maternal death worldwide. In general, transthoracic echo (TTE) relies on detecting general signs of right ventricular strain as a surrogate for diagnosing pulmonary embolism (PE), whereas TEE relies on direct visualization of thrombus to make the diagnosis. Patients deemed to be at a baseline risk for bleeding and PE represent the majority of patients undergoing total knee and hip replacement. Patients diagnosed with antiphospholipid syndrome (APS) have high rates of recurrent thrombosis after discontinuation of anticoagulation for a period of years.