Incidence of venous thromboembolism and thromboprophylaxis after total hip or knee arthroplasty

Publication Type:
Journal Article
Journal of Pharmacy Practice and Research, 2008, 38 (3), pp. 200 - 204
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Background: Despite numerous guidelines and consensus statements on venous thromboembolism (VTE) prophylaxis, there appears to be a large gap between evidence and practice. Aim: To identify the incidence of VTE, thromboprophylaxis practice, VTE risk factors, and bleeding complications in patients undergoing elective total hip or knee arthroplasty. Method: Patients who underwent elective total hip or knee arthroplasty from 1 January 2004 to 31 December 2005 were identified retrospectively from medical records at two hospitals. A clinical case audit was performed and data collected on the 3-month incidence of VTE, thromboprophylaxis practice, VTE risk factors and bleeding episodes. Results: VTE incidence was 13% (in-hospital incidence 9.3% and 3-month readmission incidence 3.3%) and was significantly higher at Hospital 1 for unilateral total knee arthroplasty (p= 0.02) and unilateral total hip arthroplasty (p = 0.02). At both hospitals the 3-month incidence of VTE was 16% post unilateral total knee arthroplasty compared to 7.7% post unilateral total hip arthroplasty (p = 0.06). 99% of patients received appropriate pharmacological prophylaxis and of these 87% received an appropriate dose. 17 patients (55%) that developed VTE had one or more risk factors. There were 23 cases (9.30%) of minor bleeding and 4 cases (1.6%) of major bleeding. Conclusion: VTE incidence was higher than that quoted in the literature, which may reflect high usage of pre-discharge deep vein thrombosis screening in the study population. There is a need to develop and disseminate management algorithms for elective total hip or knee arthroplasty in the local setting.
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