Thromboprophylaxis underused in joint arthroplasty patients
MedWire News: Postsurgical thromboprophylaxis falls short of current recommendations for patients undergoing hip and knee arthroplasty, US study data show.
These findings, from an integrated healthcare database, highlight the need to ensure pharmacological prophylaxis continues in the postdischarge outpatient setting, say the researchers.
"Current guidelines recommend a minimum of 10 days of thromboprophylaxis for patients undergoing major orthopedic surgery," explain Geno Merli (Thomas Jefferson university Hospitals, Philadelphia, Pennsylvania) and colleagues.
"As a result of the persistent risk of VTE [venous thromboembolism], extended-duration thromboprophylaxis for up to 35 days is recommended in patients with hip arthroplasty or hip fracture, and is suggested in patients with knee arthroplasty," they add.
In their study of 2382 patients undergoing knee (58.5%) or hip (41.5%) arthroplasty between 1997 and 2007, the researchers found that 72.7% and 73.9% of knee and hip arthroplasty patients, respectively, received pharmacological prophylaxis in the inpatient setting only. Low molecular weight heparins were the most common anticoagulants, used in 88.5% of cases.
A further 12.5% of knee and 12.3% of hip arthroplasty patients received both inpatient and outpatient pharmacological prophylaxis, while the remaining patients did not receive any pharmacological prophylaxis.
The researchers report that the mean length of hospital stay was 4.9 days over the study period, although the median stay decreased from 5 days in 1997 to 3 days in 2007.
Of note, the length of time on treatment was stable between 1997 and 2007, at between 2 and 4 days, but increased sharply from 2005 onwards, to 11.5 days in 2007.
The researchers point out that this increase coincided with the release of new American College of Chest Physicians guidelines in 2004, recommending a minimum thromboprophylaxis duration of 10 days for patients undergoing hip or knee arthroplasty.
Despite the recent increases in the number of patients receiving anticoagulant post-surgery, "considerable numbers of hip and knee arthroplasty patients only receive prophylaxis for part of the time period recommended by guidelines," Merli and co-authors remark.
"Further efforts are required to ensure the recommended duration of thromboprophylaxis is prescribed to all patients and continued outpatient VTE prophylaxis is provided," they conclude in the Journal of Thrombosis and Thrombolysis.
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By Laura Dean