Are the national orthopaedic thromboprophylaxis guidelines appropriate?

Abstract

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.

Thromboprophylaxis in patients undergoing total hip and knee arthroplasty: a review of current practices in an Australian teaching hospital

“…A survey evaluating the prescribing practices of orthopaedic surgeons found that commonly cited reasons for the limitation of thromboprophylaxis prescription include a perceived low risk of VTE following surgery, perception of high bleeding risk with anticoagulation and a belief that chemoprophylaxis is not superior to mechanical methods. 27 Our data indicate that there is significant heterogeneity in terms of what agents are being used for thromboprophylaxis. 18.2% (69/380) of patients received one of the NOAC for chemoprophylaxis on discharge, reflecting that there has been significant uptake of the NOAC at this centre.…”

“…It is recognised that the risk of VTE extends beyond the period of hospitalisation and in our study, 25.8% (98/380) of patients received no chemoprophylaxis on discharge, suggesting that re‐assessment of duration of chemoprophylaxis prescription represents an area of potential improvement. A survey evaluating the prescribing practices of orthopaedic surgeons found that commonly cited reasons for the limitation of thromboprophylaxis prescription include a perceived low risk of VTE following surgery, perception of high bleeding risk with anticoagulation and a belief that chemoprophylaxis is not superior to mechanical methods …”

Thromboprophylaxis following hip and knee arthroplasty

“…206 This may be because only ASA members (who had a tendency to prefer aspirin) were included in the previous survey and they only made up 23.0% of the response rate in this survey. Interestingly, surgeons who preferred to prescribe aspirin in this study tended to prescribe longer courses of prophylaxis than those who preferred to prescribe an anticoagulant ± aspirin.…”

“…Guideline, and similar to the findings reported in Chapter 6, to the general use of thromboprophylaxis following arthroplasty. 206 As noted in 9.3 Methods the survey template used in this study was a shortened version of the survey used in the study outlined in Chapter 6. While some questions differed between the two surveys, a number were identical, allowing direct comparison between the findings of each survey.…”

Initial diagnosis and management of chronic obstructive pulmonary disease in Australia: views from the coal face

“…However, the response rate was typical of other surveys of doctors' treatment practices, [42][43][44] and was considered acceptable for this form of research, especially given the relatively long questionnaire (32 questions). The analysable response rate was only 23%, and so, the data may not have provided a true representation of GP practices.…”