{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T02:02:05Z","timestamp":1769047325245,"version":"3.49.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":35,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002386","name":"Cairo University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002386","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Deep vein thrombosis (DVT) remains a major postoperative complication despite routine prophylaxis. This audit investigated an unexpected rise in DVT incidence in a tertiary surgical ward in Cairo, Egypt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A six-month retrospective audit (December 2024\u2013June 2025) included 212 adult patients undergoing general surgical procedures. All received enoxaparin prophylaxis. Clinically suspected DVTs were identified using Wells Score criteria and confirmed by duplex Doppler ultrasonography. Cold chain integrity of enoxaparin storage was reviewed in collaboration with pharmacy and biomedical engineering teams. Descriptive and comparative analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighteen patients (8.5%) were clinically suspected to have DVT within 30 days postoperatively; 14 cases (6.6%) were confirmed by Doppler. Nine occurred during index admission and five during follow-up. Eleven of 14 confirmed cases (78.6%) were temporally linked to a malfunctioning ward refrigerator with storage temperatures exceeding 25\u00a0\u00b0C. Patients with DVT were more likely to have undergone emergency surgery and less likely to have received mechanical prophylaxis, although these differences were not statistically significant. No major bleeding events were systematically recorded. Patients with DVT were more likely to have undergone emergency surgery and less likely to have received mechanical prophylaxis, although these differences were not statistically significant. By contrast, exposure to enoxaparin from the malfunctioning refrigerator was significantly associated with postoperative DVT (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cold chain failure was strongly associated with prophylaxis failure and is the most plausible contributor, though definitive pharmacological degradation was not confirmed. Infrastructure monitoring and mechanical prophylaxis adherence are essential to effective thromboprophylaxis. A prospective re-audit is scheduled following corrective measures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12893-025-03326-5","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T07:06:29Z","timestamp":1765955189000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Failure of pharmacological DVT prophylaxis due to cold chain disruption: a six-month audit from a tertiary surgical ward in Cairo"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8035-066X","authenticated-orcid":false,"suffix":"Jr.","given":"Ahmed","family":"Shafik","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2669-5108","authenticated-orcid":false,"given":"Haytham","family":"Elessawy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6442-7352","authenticated-orcid":false,"given":"Youssef Karkoucha","family":"Gobrial","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5162-5858","authenticated-orcid":false,"given":"Abdelrahman","family":"Lotfy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"issue":"9610","key":"3326_CR1","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/S0140-6736(08)60202-0","volume":"371","author":"AK Kakkar","year":"2008","unstructured":"Kakkar AK, Cohen AT, Tapson VF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study). Lancet. 2008;371(9610):387\u201394.","journal-title":"Lancet"},{"issue":"4","key":"3326_CR2","first-page":"701","volume":"93","author":"R Alikhan","year":"2005","unstructured":"Alikhan R, Cohen AT, Combe S, et al. Fatal pulmonary embolism in hospitalised patients: a multicentre study. Thromb Haemost. 2005;93(4):701\u20135.","journal-title":"Thromb Haemost"},{"key":"3326_CR3","unstructured":"National Institute for Health and Care Excellence (NICE). Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. NICE guideline [NG89]; London: National Institute for Health and Care Excellence; 2018."},{"key":"3326_CR4","unstructured":"Sanofi-Aventis. Clexane (enoxaparin sodium) Summary of Product Characteristics (SmPC). Amsterdam: European Medicines Agency; 2022."},{"issue":"9094","key":"3326_CR5","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.1016\/S0140-6736(97)08140-3","volume":"350","author":"PS Wells","year":"1997","unstructured":"Wells PS, Anderson DR, Bormanis J, Guy F, Mitchell M, Gray L, et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997;350(9094):1795\u20138.","journal-title":"Lancet"},{"issue":"1","key":"3326_CR6","first-page":"74","volume":"30","author":"M Daskalopoulos","year":"2011","unstructured":"Daskalopoulos M, Daskalakis M, Tzanakis N, et al. Evaluation of Pharmacological and mechanical thromboprophylaxis in surgical patients: a prospective Greek study. Int Angiol. 2011;30(1):74\u201380.","journal-title":"Int Angiol"},{"key":"3326_CR7","doi-asserted-by":"crossref","unstructured":"Sholkamy S. VTE Risk Evaluation and Prophylaxis in Real Life Practice in Egyptian Hospitals. Ain Shams Journal of Surgery. 2017;10(1):12\u201319.\u00a0https:\/\/asjs.journals.ekb.eg\/article_178121.html.","DOI":"10.21608\/asjs.2017.178121"},{"key":"3326_CR8","unstructured":"World Health Organization. Guidelines on the stability evaluation of vaccines for use under extended controlled temperature conditions. WHO Technical Report Series, No. 999, Annex 5. Geneva: WHO; 2016."}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-025-03326-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-025-03326-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-025-03326-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T11:20:48Z","timestamp":1768994448000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12893-025-03326-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,17]]},"references-count":8,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3326"],"URL":"https:\/\/doi.org\/10.1186\/s12893-025-03326-5","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,17]]},"assertion":[{"value":"27 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical review and approval were waived by the\n                      Kasr Al Ainy Faculty of Medicine Research Ethics Committee, Cairo University\n                      , as this audit involved retrospective analysis of anonymized patient data collected under institutional quality-assurance policy, in accordance with the Declaration of Helsinki (2013 revision).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"62"}}