MBBS OSCE · General Surgery
OSCE — Perioperative VTE Prophylaxis
Eight-minute OSCE station on perioperative VTE prophylaxis: Caprini/Padua risk, ACCP ladder, trial doses, and PE with hypotension.
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Brief (to candidate)
You will assess a patient with a presentation consistent with perioperative VTE prophylaxis.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Venous thromboembolism (VTE) = DVT + PE. ACCP 9th edition: a common cause of preventable death in surgical patients. ENDORSE: 64.4 percent of surgical inpatients at high risk, only 58.5 percent prophylaxed. Ladder: very low — ambulation; low — IPC; moderate — LMWH, low-dose UFH or IPC; high — drug plus elastic stockings or IPC. Trial doses: enoxaparin 40 mg SC once daily, dalteparin 5000 IU once daily, fondaparinux 2.5 mg once daily, apixaban 2.5 mg twice daily, dabigatran 220 mg once daily. Four weeks of LMWH after abdominal or pelvic cancer surgery; 10 to 14 days (extendable to 35) after hip or knee replacement. PE with hypotension: systemic thrombolytic therapy.
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (neuraxial LMWH timing, cancer four-week LMWH, or HIT 4Ts).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | VTE = DVT + PE; ACCP "common cause of preventable death in surgical patients" |
| Assessment | Caprini (surgical) or Padua (medical, high risk = 4 or more); parallel bleeding risk |
| Investigations | Suspected DVT: compression ultrasound; suspected PE: CTPA. No discharge duplex screening |
| Emergency care | PE with hypotension: oxygen, anticoagulation, systemic thrombolysis (CHEST) |
| Definitive care | Names enoxaparin 40 mg SC OD as prophylaxis vs 1 mg/kg BD as Levine therapeutic dose |
| Safety | HIT: 4Ts, stop all heparin, non-heparin anticoagulant |
| Safety | Neuraxial: at least 12 h after low-dose LMWH, 24 h after intermediate-dose (HIGHLOW) |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when hypotensive. Use guideline-standard prophylaxis with named agents and durations. Document Caprini/Padua and bleeding risk. A safe candidate is specific, structured, and never delays critical care for a postoperative D-dimer.