Prevention of venous thromboembolism after total hip and knee
arthroplasties in Australian hospitals: A call for concord
Abstract
Purpose: Venous thromboembolism (VTE) is a leading cause of
preventable morbidity and mortality, with total hip arthroplasty (THA)
and total knee arthroplasty (TKA) at the highest risk. Safe and
appropriate thromboprophylaxis is essential. However, investigations
into prescribing practices have only had limited investigation.
Aims: To describe current VTE prophylaxis regimens in
Australian patients following an elective THA/TKA and compare these
regimens to an international standard. Methods: A retrospective
multisite cohort study of patients admitted for a THA/TKA in six
tertiary hospitals in Queensland, Australia was conducted over 12
months. Patient and medication data were collected following surgery and
for 60 days after discharge to determine changes to their
thromboprophylaxis regimen. Results were summarised and compared to NICE
guidelines. Results: 1,011 patients (43.1% THA, 56.9% TKA)
were included and thromboprophylaxis was used in 98.1% of inpatients
and in 94.3% of discharge patients for 5.2 (±5.23) and 29.2 (±15.9)
days, respectively. Low-molecular-weight heparins were the primary drugs
for inpatients (71.2%), and aspirin 150mg for discharge (42.0%), most
commonly for 6 weeks (31.8%). Generally, a two-staged prophylaxis
regimen was implemented; most commonly any anticoagulant as an
inpatient, followed by rivaroxaban on discharge (32.7%) or an
anticoagulant as an inpatient with aspirin on discharge (26.4%).
Overall, adherence to NICE guidelines was low; THA: 8.7%, TKA: 5.9%.
Conclusion: VTE prophylaxis regimens varied considerably and
consequently, adherence to international guidelines was low. There is a
need for local, peer-led guidelines to ensure consistent, safe, and
effective prophylaxis.