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Impact of thromboprophylaxis guidelines on clinical outcomes following total hip and total knee replacement

Rita Selby1, Bijan J Borah, Heather P McDonald

  • 1Division of Hematology, University of Toronto, Toronto, Canada.

Thrombosis Research
|February 28, 2012
PubMed

Insights

Only 40% of hip and knee replacement patients receive recommended blood clot prevention. Not receiving this prophylaxis significantly increases the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE).

Area of Science:

  • Orthopedic Surgery
  • Cardiology
  • Pharmacology

Background:

  • The American College of Chest Physicians (ACCP) provides guidelines for thromboprophylaxis in total hip replacement (THR) and total knee replacement (TKR) patients.
  • Real-world adherence to these guidelines and its impact on patient outcomes remain under investigation.

Purpose of the Study:

  • To assess adherence to ACCP thromboprophylaxis guidelines in THR/TKR patients.
  • To compare venous thromboembolism (VTE) and bleeding event rates between patients receiving guideline-recommended prophylaxis and those who did not.

Main Methods:

  • Retrospective observational study utilizing a US health plan claims database linked to inpatient medication and mortality data.
  • Analysis of THR/TKR patients who underwent surgery between April 2004 and December 2006.
  • Comparison of VTE and bleeding events using chi-squared tests and multivariate logistic regression.

Main Results:

  • Only 40% of 3,497 analyzed patients received ACCP-recommended thromboprophylaxis.
  • Non-ACCP patients had nearly double the risk of DVT (3.76% vs. 2.01%) and over eight times the risk of PE (1.19% vs. 0.14%) compared to ACCP patients.
  • No significant difference in bleeding rates was observed between the groups.

Conclusions:

  • Adherence to ACCP thromboprophylaxis guidelines in THR/TKR patients is suboptimal in the US.
  • Failure to receive ACCP-recommended thromboprophylaxis is an independent risk factor for developing DVT and PE post-surgery.
Abstract

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