Fewer than 5% of Australian patients having hip or knee arthroplasty in the past received guideline-recommended therapy to prevent venous thrombosis, according to a study at the Royal Hobart Hospital published in the July issue of the Internal Medicine Journal. Corinne Mirkazemi, from the University of Tasmania School of Pharmacy and her colleagues, reviewed the records of 300 patients treated between 2007 and 2009.
They found two cases of symptomatic deep vein thrombosis or pulmonary embolism that occurred during the initial hospital admission and another six cases that occurred after discharge. All had taken place within one month of the surgeries. The overall incidence of 2.7% was similar to that reported in other studies.
“All inpatients received pharmacological thromboprophylaxis, predominantly injectable anticoagulants, ” Mirkazemi, said. “However, they found that only 37% of the patients continued to receive treatment after their discharge. The most common departure from the accepted guidelines at the time of the study was an inadequate duration of therapy, which was recommended to continue for at least 10 days after knee arthroplasty and 28 to 35 days after hip arthroplasty.”
The study noted that, in 2009, surgeons were often reluctant to persist with treatment because of the perceived risks of major bleeding. In response to that perceived reluctance, the Arthroplasty Society of Australia published an article with recommendations for surgeons to conduct risk assessments for each patient. This lack of consensus on optimal care meant that many patients failed to receive thromboprophylaxis conforming to any of the current guidelines, Mirkazemi said.
