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Home prophylactic warfarin anticoagulation program after hip and knee arthroplasty
1Department of Surgery, Queen's University, Kingston, Ont.
Canadian Journal of Surgery. Journal Canadien De Chirurgie
|October 20, 1999
Summary
A program to maintain oral anticoagulation after hip and knee surgery showed suboptimal results. Most patients had international normalized ratio (INR) values outside the target range post-discharge, indicating challenges in achieving therapeutic anticoagulation.
Area of Science:
- Orthopedic Surgery
- Pharmacology
- Quality Improvement
Background:
- Effective anticoagulation is crucial for preventing thromboembolism after hip and knee arthroplasty.
- Maintaining prophylactic oral anticoagulation within the target international normalized ratio (INR) range (2.0-3.0) is essential for patient safety and treatment efficacy.
- Existing outpatient warfarin programs face challenges in achieving consistent therapeutic INR levels.
Purpose of the Study:
- To evaluate the efficiency of a quality improvement program aimed at maintaining prophylactic oral anticoagulation within the target INR range for six weeks post-hip and knee arthroplasty.
- To assess the proportion of INR values within, below, and above the therapeutic range in patients managed by an outpatient warfarin program.
Main Methods:
- Prospective continuous quality improvement study conducted at a tertiary care university hospital.
- Involved patients undergoing hip or knee arthroplasty requiring postoperative thromboembolism prophylaxis.
- Utilized an outpatient warfarin program with patient information, Home Care coordination, and family physician-led dosage adjustments.
Main Results:
- Sixty-two patients were enrolled over three months.
- At hospital discharge, 64% of patients had INR values within the target range (2.0-3.0), with 31% below and 5% above.
- Post-discharge, only 42% of INR values were within the target range, while 48% were below and 10% were above.
Conclusions:
- The implemented outpatient warfarin program demonstrated suboptimal control of home INR values.
- Existing resources within Home Care and family physician practices were insufficient to achieve tight INR control.
- Improvements in patient information, physician communication, and laboratory services are necessary to enhance anticoagulation management post-arthroplasty.