Thromboprophylaxis in patients undergoing total hip and knee arthroplasty: a review of current practices in an Australian teaching hospital

R E Pow, P R Vale
Internal Medicine Journal 2015, 45 (3): 293-9

BACKGROUND: Venous thromboembolism (VTE) remains a cause of significant morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Prophylaxis significantly reduces the rate of VTE following these procedures. Previous studies report suboptimal uptake of guideline recommended thromboprophylaxis.

AIMS: To describe VTE prophylaxis prescribing practices in a major hospital for joint replacement surgery. To determine the proportion of patients receiving guideline recommended thromboprophylaxis. To define the incidence of in-hospital VTE following THA and TKA.

METHODS: A retrospective chart review of 402 consecutive patients undergoing THA or TKA from June to October 2013. Patient characteristics, operative and anaesthetic factors, details of thromboprophylaxis and the incidence of in-hospital VTE are reported. Comparison is made with recent guidelines.

RESULTS: Four hundred and two patients underwent THA (n = 202) or TKA (n = 200). Ninety-nine per cent of patients received mechanical prophylaxis. One hundred percent of patients received chemoprophylaxis in hospital. Enoxaparin was most commonly prescribed followed by aspirin. Patients undergoing TKA were more likely to receive an anticoagulant (89.9% vs 47.8% for THA, P < 0.05). 74.5% received chemoprophylaxis on discharge (mean duration 22.1 days). The incidence of in-hospital VTE was 4.7%.

CONCLUSIONS: The proportion of study patients receiving thromboprophylaxis compares favourably with prior research. The overall incidence of VTE is higher than that demonstrated in major orthopaedic trials. Inadequate duration of chemoprophylaxis remains a potential area of improvement. Extended prophylaxis should be prescribed as per current guidelines. Comparison between efficacy and safety of various agents is the subject of future research.

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