Are the national orthopaedic thromboprophylaxis guidelines appropriate?

To identify enablers and barriers to thromboprophylaxis prescribing following hip and knee arthroplasty, from the perspective of orthopaedic surgeons.

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 guidelines.

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.

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.