Stroke Risk - recent surgery

[DieselBolus17]

hello all,

Was wondering the patho behind recent surgeries as being a stroke risk. I know that periods of immobility are a risk due to slowing of blood flow increasing the chances of blood to clot. Is surgery more or less the same reason? Since you're more likely to be bedridden for a bit after surgeries?

Thanks.

 

[Ewok Jerky]

That plus increased risk of stasis from any kind of turnaquet used for extremety surgeries and direct vascular injuries forming clots.

 

[Carlos Danger]

First, are you talking about the immediate periop period, or the weeks following?

Any specific population or surgery type?

 

[jwk]

Not every type of surgery poses a stroke risk - and with current-day DVT/PE prophylaxis (sequential compression device for legs, anticoagulant therapy, early ambulation) the risk is far less than it was even 10 years ago. Things like total hips and knees, which used to stay in bed for a few days (and had a relatively high risk of PE) are now ambulated a few hours after surgery and being done on an outpatient basis.

 

[cannonball88]

A couple of things related to a recent surgery that can increase risk of a clot:

1. Limb Surgery (arms/legs): Often times there will be a tourniquet placed proximal to the limb. As the blood "settles," obviously, it can form a clot which may lead to a stroke.
2. Rest: Especially in surgeries with a longer-term recovery, the simply act of moving less can increase the ability for blood to clot (hence why people who are post-embolus or post-thrombus are encouraged to get out and walk every hour during a long drive.
3. Healing: How does the body naturally heal wounds? It clots. In larger wounds, the clot can be larger, and there is, of course, a chance of a piece breaking off and going where it will.

Hope I helped!

 

[Brandon O]

The post-injury (surgery is an injury) inflammatory response is coagulogenic as well.

 

[Ewok Jerky]

Virchow's triad: stasis, hypercoaguable state, vascular injury

 

[Carlos Danger]

Virchow's triad: stasis, hypercoaguable state, vascular injury

I was trying to remember that, and for the life of me I couldn't.....