Venous Thromboembolism Prophylaxis Compliance in Orthopedic Patients With Cardiac Risk Factors

Introduction Venous thromboembolism (VTE) is a critical condition that includes deep vein thrombosis (DVT) and pulmonary embolism (PE), both of which can lead to severe complications, including death, if not adequately managed. Objective This study aimed to evaluate adherence to prophylactic measures and identify factors influencing compliance. Methodology This study was done in Shalamar Hospital, Lahore, from October 2023 to October 2024. Baseline assessments were conducted to gather demographic and clinical data, including age, gender, body mass index (BMI), comorbidities, and cardiac risk factors such as atrial fibrillation or coronary artery disease. Details of the surgical procedures, including type, duration, and anesthesia used, were also recorded. Compliance with VTE prophylaxis was monitored through patient interviews, direct observation, and medical record reviews. Pharmacological prophylaxis compliance involved evaluating the administration of anticoagulants regarding dosage, timing, and frequency. Mechanical prophylaxis adherence was assessed by monitoring the use of compression stockings and pneumatic devices. Compliance was measured as the percentage of patients who adhered to the prescribed prophylaxis protocols. Primary outcomes included the incidence of VTE events, such as DVT or PE, within 30 days post-surgery. Follow-ups were conducted through in-person visits or telephonic interactions to monitor compliance and postoperative outcomes. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). Continuous variables, such as age and BMI, were summarized using means and standard deviations, while categorical variables, like compliance rates, were expressed as frequencies and percentages. Subgroup analyses were conducted to identify variations in compliance rates based on demographic and clinical factors using t-tests. Results The study included 90 patients, with a mean age of 58.9±8.4 years and a nearly equal gender distribution (54% male and 46% female). The mean BMI of the participants was 28.5±3.2 kg/m². Hypertension was the most common cardiac risk factor, affecting 67% (n=60) of patients, followed by atrial fibrillation (22%; n=20) and heart failure (11%; n=10). Among the surgeries, 65% (n=58) were elective, while 35% (n=32) were emergency procedures. VTE incidence was 6.7% (n=6), with 4.4% (n=4) developing DVT and 2.2% (n=2) experiencing PE. Bleeding complications occurred in 8.9% (n=8) of patients, with 6.7% (n=6) experiencing minor bleeding and 2.2% (n=2) reporting major bleeding. Patients undergoing elective surgeries exhibited higher pharmacological compliance at 78% (n=45) and mechanical compliance at 88% (n=51), resulting in an overall compliance rate of 84% (n=49). In contrast, patients undergoing emergency surgeries had lower compliance rates, with 63% (n=20) for pharmacological prophylaxis and 69% (n=22) for mechanical prophylaxis, leading to an overall compliance rate of 63% (n=20). Conclusion It is concluded that compliance with VTE prophylaxis plays a pivotal role in reducing the risk of thromboembolic events in orthopedic patients with cardiac risk factors.