Mirkazemi, C and Bereznicki, LR and Peterson, GM, Thromboprophylaxis following hip and knee arthroplasty, Internal Medicine Journal, 43, (2) pp. 124-129. ISSN 1444-0903 (2013) [Refereed Article]
Copyright 2012 Royal Australasian College of Physicians
Official URL: http://dx.doi.org/10.1111/j.1445-5994.2012.02864.x
Aim: To determine local thromboprophylaxis prescribing practices following arthroplasty.
Methods: A retrospective review was performed of 300 consecutive hip and knee arthroplasty patients (150 each) over a 2-year period at Tasmania’s major public hospital. The provision of thromboprophylaxis, the presence of bleeding/thrombotic risk factors and the prevalence of symptomatic venous thromboembolism (VTE) and major bleeding occurring within 90 days postoperatively were documented.
Results: The mean age of the 300 patients (169 females, 131 males) was 68.7 years (standard deviation 10.4). Only 11.3% of knee arthroplasty and 16.7% of hip arthroplasty inpatients had mechanical thromboprophylaxis documented during their stay. All inpatients received pharmacological thromboprophylaxis, predominantly injectable anticoagulants (98.4%). Only 36.5% continued to receive pharmacological thromboprophylaxis following discharge, predominantly an antiplatelet agent (55.5%). The 90-day incidence of symptomatic VTE was 2.7% (95% confidence interval: 1.0–5.0%); 4.0% (95% confidence interval: 1.0–8.0%) for knees and 1.3% (95% confidence interval: 0–5.0%) for hips. The in-hospital and post-discharge VTE incidence was 0.7% and 2.0% respectively. All readmissions for VTE occurred within 1 month of surgery.Conclusions: While inpatient thromboprophylaxis was routine, it generally was not continued on discharge, potentially leaving many patients exposed to a higher risk of VTE. Most cases of symptomatic VTE occurred after discharge, with the majority requiring readmission to hospital under medical units.Within the limitations of a retrospective study, these findings suggest a need for further research and discussion regarding what constitutes appropriate thromboprophylaxis (type, agent and duration) following hip or knee arthroplasty.
|Item Type:||Refereed Article|
|Keywords:||arthroplasty, hip, knee, replacement, guideline, thromboprophylaxis|
|Research Division:||Medical and Health Sciences|
|Research Group:||Pharmacology and Pharmaceutical Sciences|
|Research Field:||Clinical Pharmacology and Therapeutics|
|Objective Group:||Clinical Health (Organs, Diseases and Abnormal Conditions)|
|Objective Field:||Blood Disorders|
|Author:||Mirkazemi, C (Mrs Corinne Mirkazemi)|
|Author:||Bereznicki, LR (Professor Luke Bereznicki)|
|Author:||Peterson, GM (Professor Gregory Peterson)|
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