Acute pulmonary embolism after gastrointestinal surgery

The incidence of Venous Thromboembolism (VTE) after gastrointestinal surgery has been increasing, although it is lower in Japan compared to that in the west. Pulmonary Thromboembolism (PE) is the most critical complication after gastrointestinal surgery. Primary prevention of VTE must be considered for all patients who undergo surgery. The risk of VTE is classified into four levels: low, intermediate, high and highest. Each surgical or disease risk level should be evaluated comprehensively considering additional risk factors. Methods to prevent VTE are early ambulation and active exercise after surgery, elastic stocking, intermittent pneumatic compression and anticoagulation therapy using low-dose unfractionated heparin, low molecular weight heparin or Factor Xa inhibitors. Early ambulation and active exercise are employed for low risk patients and elastic stockings or IPC are employed for intermediate risk patients. IPC or anticoagulation therapy is employed for high risk patients. Anticoagulation therapy plus IPC or elastic stocking are employed for highest risk patients. Surgeons must be cautious about postoperative bleeding after anticoagulation therapy.