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Thromboprophylaxis following hip and knee arthroplasty

Citation

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 Statement

Copyright 2012 Royal Australasian College of Physicians

Official URL: http://dx.doi.org/10.1111/j.1445-5994.2012.02864.x

DOI: doi:10.1111/j.1445-5994.2013.02864.x

Abstract

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 Details

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 Division:Health
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)
ID Code:78634
Year Published:2013
Deposited By:Pharmacy
Deposited On:2012-07-11
Last Modified:2014-05-23
Downloads:0

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