Are the national orthopaedic thromboprophylaxis guidelines appropriate?
Mirkazemi, C and Bereznicki, LR and Peterson, GM, Are the national orthopaedic thromboprophylaxis guidelines appropriate?, ANZ Journal of Surgery, 82, (12) pp. 913-917. ISSN 1445-1433 (2012) [Refereed Article]
Copyright 2012 The Authors ANZ Journal of Surgery & Royal Australasian College of Surgeons
Background: To identify enablers and barriers to thromboprophylaxis prescribing
following hip and knee arthroplasty, from the perspective of orthopaedic surgeons.
Methods: An invitation to participate in an online survey was distributed electronically
to Arthroplasty Society of Australia members (n = 103). The survey collected
demographic details, thromboprophylaxis attitudes and clinical practice of the orthopaedic
surgeons, and explored their familiarity with contemporary national and international
Results: Twenty-five surgeons (24%) completed the survey, all male with a median of
20 years of practice as orthopaedic surgeons (range: 8–27 years). Most surgeons (92%)
practised predominantly in the private sector, and conducted both hip and knee arthroplasties
each month. While all surgeons prescribed chemoprophylaxis following
arthroplasty, most surgeons (64%) were uncertain to what extent it would prevent fatal
pulmonary embolism (PE). The pharmacological agents of choice were low molecular
weight heparin (48%) and aspirin (44%). One-third of surgeons were not familiar with
the National Health and Medical Research Council recommendations for thromboprophylaxis
in hip and knee arthroplasty patients. After reviewing a summary of the
recommendations, most surgeons (80%) indicated they were inappropriate, commonly
citing that they were grounded on an insufficient evidence base and should include
aspirin as a sole chemoprophylaxis option.
Conclusion: There are clearly strong barriers to the translation of current thromboprophylaxis
guidelines into practice. Many surgeons doubt the effectiveness of chemoprophylaxis
to prevent fatal PE, perceive the risk of venous thromboembolism
following surgery to be low, are unfamiliar with current national guidelines or believe
the guidelines are grounded on inappropriate evidence.