Thromboprophylaxis Following Hip and Knee Surgery A Review of Current Practices in a Canadian Tertiary Care Center

Main Article Content

Lilia Panamsky
Sarah Gomes
Elizabeth McAuley
Wilma Hopman
Kristen Marosi
Siddhartha Srivastava

Keywords

thromboprophylaxis, arthroplasty, VTE

Abstract

Objective: We aimed to describe the current pharmacologic thromboprophylaxis practice after total hip arthroplasty (THA) and total knee arthroplasty (TKA) at a tertiary care center in Canada.


Methods: A retrospective cohort study was conducted on patients following elective arthroplasty or fracture surgery between March 1, 2019 and March 31, 2020. The primary outcome was the rate of use of different anti-thrombotic medications. Secondary outcomes included duration of antithrombotic therapy, adherence to major international guidelines, 30-day venous thromboembolism (VTE) incidence, and bleeding complications.


Results: Over 98% of patients were prescribed pharmacoprophylaxis in hospital and on discharge. Inpatient VTE prophylaxis was predominantly dalteparin (64.5%) and aspirin (ASA; 34.1%) for THA, and dalteparin (65.5%) and ASA (33.1%) for TKA. Discharge prescriptions had dalteparin (60.2%) and ASA (36.9%) for THA compared to ASA (56.5%), dalteparin (28.2%), and combined dalteparin with ASA (12.3%) for TKA. There was minimal use of direct oral anticoagulants (DOAC) in either type of surgery (<1%). The average total duration of prophylaxis after THA and TKA was 34.7 days (±8.2 days) and 36.6 days (±11.3 days), respec-tively. The 30-day incidence rate of post-operative VTE was 1.6% and the 30-day bleeding rate was 2.2%.


Conclusion: There was nearly universal prescribing of postoperative VTE prophylaxis and high rate of adherence to international guidelines. There was, however, considerable variability in practice of prescribing, particularly following TKA. Use of DOAC remained negligible in both types of surgeries.


Résumé
Objectif : Cet article vise à décrire la pratique actuelle de la thromboprophylaxie pharmacologique après une arthroplastie totale de la hanche (ATH) et une arthroplastie totale du genou (ATG) dans un centre de soins tertiaires au Canada.


Méthodologie : Une étude de cohorte rétrospective a été réalisée chez des patients ayant subi une arthro-plastie ou une opération pour une fracture non urgente entre le 1er mars 2019 et le 31 mars 2020. Le critère d’évaluation principal est la fréquence d’utilisation de différents antithrombotiques. Les critères d’évalua-tion secondaires sont la durée du traitement antithrombotique, l’observance des principales lignes direc-trices internationales, l’incidence de la thromboembolie veineuse (TEV) à 30  jours et les complications hémorragiques.


Résultats : Plus de 98 % des patients se sont fait prescrire une pharmacoprophylaxie à l’hôpital et à leur sortie. Les médicaments administrés en prophylaxie contre la TEV à l’hôpital sont surtout la daltéparine (64,5 %) et l’acide acétylsalicylique (AAS) (34,1 %) pour l’ATH et la daltéparine (65,5 %) et l’AAS (33,1 %) pour l’ATG. Les médicaments prescrits à la sortie de l’hôpital sont la daltéparine (60,2 %) et l’AAS (36,9 %) pour l’ATH, tandis que pour l’ATG, il s’agit de l’AAS (56,5 %), de la daltéparine seule ou en combinaison (28,2 %), puis de l’AAS (12,3 %). L’utilisation d’anticoagulants oraux directs (AOD) est minime dans les deux types d’intervention chirurgicale (< 1 %). La durée totale moyenne de la prophylaxie après l’ATH est de 34,7 jours (± 8,2 jours) et de 36,6 jours (± 11,3 jours) après l’ATG. Le taux d’incidence de la TEV postopératoire à 30 jours est de 1,6 % et le taux d’hémorragie à 30 jours est de 2,2 %.


Conclusion : La prescription de médicaments contre la TEV en prophylaxie est presque universelle et le taux d’observance des lignes directrices internationales est élevé. Toutefois, la variabilité est considérable en ce qui concerne les pratiques de prescription, particulièrement après l’ATG. L’utilisation d’AOD demeure négligeable dans les deux types d’intervention chirurgicale.

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