How Surgeons Prevent Deep Clots During Long Procedures

Long surgeries can save lives but they also come with risks. One such risk is the development of deep vein thrombosis (DVT), a serious condition where blood clots form in deep veins, often in the legs. If not caught early, these clots can travel to the lungs, causing a potentially fatal pulmonary embolism (PE).To minimize this risk, surgeons and medical teams take several well-planned precautions before, during, and after the operation. In this blog, we'll explore how surgeons prevent deep clots during long procedures, especially in the Indian hospital setting, and what patients and caregivers should know.

What is the risk of blood clots during surgery?

Surgical procedures, especially those lasting more than 90 minutes, significantly increase the risk of deep clots. This happens due to:

• Reduced mobility: Immobility during surgery slows down blood circulation, which can lead to clot formation.
• Tissue damage: Surgery may cause injury to blood vessels, releasing substances that trigger clotting.
• Inflammation: The body’s response to surgical stress can make blood more prone to clotting.

Certain surgeries, like orthopedic procedures (hip/knee replacements), abdominal surgeries, or cancer surgeries, carry an even higher risk. The risk is also greater if the patient is older, overweight, has a history of clots, or suffers from conditions like cancer or heart disease.

How do doctors assess a patient’s clotting risk before surgery?

Before any major procedure, doctors perform a clotting risk assessment to determine how likely a patient is to develop DVT or PE. This includes:

• Medical history check: Looking for previous clots, family history, or clotting disorders.
• Current medications: Some medicines increase clotting risk or interact with blood thinners.
• Lab tests: Blood tests like coagulation profiles, D-dimer tests, or platelet counts.
• Other factors: Age, mobility level, BMI, cancer status, and whether the patient smokes.

Based on this risk level (low, moderate, or high), the surgical team tailors the preventive measures accordingly.

What steps are taken during surgery to prevent clots?

Surgeons use a combination of mechanical and pharmacological strategies during long procedures to reduce the risk of clot formation. Here's what typically happens:

1. Mechanical Measures

These aim to keep the blood flowing during surgery:

• Intermittent pneumatic compression (IPC) devices: These sleeves are wrapped around the patient’s legs and periodically inflate to mimic walking movement.
• Compression stockings: Graduated compression stockings (GCS) help improve venous blood return.
• Proper positioning: Surgeons ensure the limbs are positioned to prevent venous stagnation.

2. Pharmacological Measures

Blood-thinning medications, or anticoagulants, are used in moderate to high-risk cases.

• These medications are typically started preoperatively or shortly after surgery.
• One such medication commonly used in India is Evaparin 40, which contains Enoxaparin, a low molecular weight heparin (LMWH) that helps prevent the formation of new clots without significantly increasing bleeding risk.

How do surgeons manage the risk of bleeding while using blood thinners?

Using blood thinners during or after surgery always involves a balancing act—too much can lead to excessive bleeding, while too little increases the clotting risk.To manage this, surgeons and anesthesiologists:

• Adjust the dosage: dose is Based on the patient's weight, age, and kidney function.
• Monitor clotting time: Regular blood tests ensure the blood isn’t too thin.
• Time the doses carefully: Anticoagulants are usually given after bleeding risk reduces post-surgery.
• Pause certain medications: If the surgery is high-risk, some blood thinners may be stopped a day or two before and resumed later.

What precautions are taken after surgery to avoid clots?

Post-operative care is just as important. Preventive steps continue well after the surgery, especially for patients who remain immobile or hospitalized for extended periods.Some common after-surgery clot prevention measures include:

• Early mobilization: Patients are encouraged to get out of bed and walk as soon as possible.
• Continued use of IPC devices or compression stockings.
• Extended use of anticoagulants: In high-risk patients, medications like LMWH may be continued for 7–14 days or longer post-surgery.
• Hydration and leg exercises: Encouraging fluid intake and foot/leg movements helps promote blood flow.

For orthopaedic surgeries or cancer-related procedures, blood thinners may be continued for up to 4 weeks post-op, depending on the risk.

Who is more likely to get blood clots after surgery in India?

In Indian settings, certain population groups may face a higher risk of DVT due to lifestyle and systemic healthcare factors. These include:

• Elderly patients who are bedridden post-surgery.
• Overweight or obese individuals, especially those undergoing bariatric surgery.
• Patients with diabetes, cancer, or cardiovascular conditions.
• Women on hormone therapy or contraceptives.
• Limited access to preventive care in rural or smaller hospitals.

Doctors in India are increasingly using risk calculators and adhering to global protocols like the Caprini score to guide clot prevention strategies in surgical patients.

Can deep clots be completely avoided?

While there’s no way to guarantee zero risk, the likelihood of deep clots can be drastically reduced through:

• Thorough risk screening before surgery.
• Proper use of anticoagulants and mechanical aids.
• Careful surgical technique and minimal operating time.
• Active post-operative rehabilitation and follow-up.

Conclusion

Surgical teams place a high premium on preventing deep vein thrombosis during lengthy surgeries. Surgeons take a comprehensive approach to preventing blood clots, which includes encouraging early mobility and using blood thinners like low molecular weight heparins. The procedure and the patient's condition may cause slight variations in the methods. The objective, however, is still the same: to guarantee a safe recovery and lower the possibility of potentially fatal complications.If you're scheduled for a long surgery or caring for someone who is, ask the doctor about DVT prevention. The right questions and the right precautions can make all the difference in recovery.