Arterial and venous thromboses are common serious postoperative complications (about 8% of surgical procedures are followed by a thrombosis). The fact that they are still so common despite years of research suggests we haven’t yet cracked what causes them and how to prevent them. Although some risk factors like malignancy and previous thromboembolism are well established, others are less clear.

A large observational study by Donzé and colleagues finds that patients with signs of systemic inflammation or sepsis in the preoperative period had a roughly threefold increased risk of postoperative arterial or venous thrombosis up to 30 days after surgery. The incidence ranged from 0.4% to 1.8%, depending on the patient subgroup. They also found a dose response effect, meaning that patients with more severe sepsis had an even greater risk of thrombosis.

In a linked editorial, Paul Myles unpicks what the results mean for clinical practice. He says it’s reasonable that patients with sepsis should be more intensively monitored and thromboprophylaxis guidelines fully implemented. However, because of the observational nature of the data he cautions against direct changes in practice until more definitive results from large randomised trials are available.
For those of you who enjoy a diagnostic challenge, have a look at our Endgames quiz.  It illustrates the age old, saying that “common things are common.” But as the case shows, it doesn’t necessarily follow that “common things aren’t missed.”

And finally, the debate that continues to get everyone going is: “Should patients be able to email their general practitioner?”  The recent poll suggests the verdict is evenly split (47% yes, 53% no, at the time of writing). We’ve had several more responses to the article over the weekend, one of which is from Azeem Majeed, who has done his own audit of emails. Over the past year, he’s had 84 email contacts with patients, only one of which was for a clinical query. He concludes that “the great majority of patients are aware that email is not a suitable medium for obtaining clinical advice.”

Do send us your thoughts and experiences. Rapid responses can be submitted for every article in The BMJ; some are published as formal letters to the editor.

 

Giselle Jones is specialist reviews editor, The BMJ.