Improved VTE Prevention Required in Discharged Orthopedic Surgery Patients, Study Suggests
A study by researchers at the University of California at Irvine, presented at the 51st Annual Meeting and Exposition of the American Society of Hematology in New Orleans, evaluated and characterized inhospital and post-discharge venous thromboembolism (VTE) prophylaxis patterns for American orthopedic surgery patients.
Patients who undergo major orthopedic surgery are at significant risk of developing VTE. As 40% to 60% of orthopedic surgery patients develop VTE in the absence of thromboprophylaxis, evidence-based guidelines recommend pharmacological VTE prophylaxis in all patients without contraindications. As the risk of VTE persists beyond discharge in these patients, the use of low molecular weight heparin and warfarin following discharge is both suitable and recommended, according to the University of California researchers. However, a lack of awareness and education often leads to an absence of such VTE prophylaxis.
In the research, inpatient data were cross-matched at the individual patient level with outpatient data from a multi-institution database (January 2005 to December 2007) to assess VTE prophylaxis patterns in major orthopedic surgery who had no contraindications for anticoagulation. Inpatients were assessed for the anticoagulant received in-hospital and were followed post-discharge to assess their outpatient prophylaxis use. Drug utilization and clinical practice patterns during and within 30 days after hospitalization were collected and compared descriptively between groups.
Of the 3311 orthopedic surgery discharges at risk of VTE and included in the analysis, only 295 (8.9%) did not receive any anticoagulation. Of the remaining 3016 (91.1%) discharges that did receive anticoagulation, 1061 (35.2%) received enoxaparin, 1028 (34.1%) received warfarin, and the remaining 927 (30.7%) received other or combination prophylaxis. However, after discharge only 1800 (54.4%) of all patients received prophylaxis, with the majority receiving warfarin (1028, 57.1%). The remaining 1511 (45.6%) received no outpatient prophylaxis.
Although the rate of prophylaxis was high in inpatients, the researchers concluded, approximately half of all patients had no prophylaxis post-discharge. Further efforts to improve VTE prevention in discharged orthopedic surgery patients are required, they note.