Current state of medical thromboprophylaxis in Australia

Noël, Sophie

doi:10.4066/amj.2014.1915

Cited by 3 publications

(6 citation statements)

References 24 publications

(23 reference statements)

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“…Anticoagulant VTE prophylaxis is recommended and widely used following THA and TKA, but all anticoagulants have inherent risk of bleeding. It is becoming understood that both from a patient and payer’s perspective, it is pivotal to balance the risk of VTE and bleeding [10, 15]. Until now, discussion and comparison of prophylaxis modalities has focused on clinical efficacy and safety.…”

Section: Discussionmentioning

confidence: 99%

“…The evidence-based VTE prophylaxis called for by Duff et al is usually found in the clinical guidelines. The utility of a national guideline on VTE prophylaxis in Australia has been called into question [10] and was rescinded in 2016 [11]. A number of local and association guidelines are though available [5, 12, 13].…”

Section: Introductionmentioning

confidence: 99%

“…The risk of bleeding is hard to predict [16]. Bleeding events after major surgery can have serious and substantial clinical consequences, impacting on both patient quality of life and total healthcare costs, and hence these events must be balanced against the anticoagulants’ benefits for VTE prevention [10, 15].…”

Section: Introductionmentioning

confidence: 99%

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A comparative cost-effectiveness analysis of mechanical and pharmacological VTE prophylaxis after lower limb arthroplasty in Australia

Torres

Saunders

2019

J Orthop Surg Res

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Background Venous thromboembolism (VTE) is a complication following surgery. Low-molecular-weight heparin (LMWH) or direct oral anticoagulants (DOACs) are efficacious but come with inherent bleeding risk. Mechanical prophylaxis, such as intermittent pneumatic compression (IPC), does not induce bleeding but may be difficult to implement beyond the immediate post-operative period. This study compared the cost and quality-adjusted life years (QALYs) saved of commonly used VTE prophylaxis regimens after lower limb arthroplasty. Methods A previously published cost-utility model considering major efficacy and safety endpoints was updated to estimate the 1-year cost-effectiveness of different VTE prophylaxis regimens. The VTE strategies assessed included apixaban, dabigatran, rivaroxaban, LMWH, IPC, IPC + LMWH and IPC + apixaban. Efficacy data were derived from studies in PubMed, and cost data came from the 2017 Australian AR-DRG and PBS pricing schemes. Results Costs for VTE prophylaxis including treatment of its associated complications over the first year after surgery ranged from AUD $644 (IPC) to AUD $956 (rivaroxaban). Across 500 simulations, IPC was the cheapest measure in 73% of simulations. In 97% of simulations, a DOAC was associated with the highest resulting QALYs. Compared to IPC, apixaban was cost-effective in 76.4% of simulations and apixaban + IPC in 87.8% of simulations. For VTE events avoided, the DOACs and IPC were on par. LMWH and LMWH + IPC were negatively dominated. Conclusions Apixaban, IPC or a sequential/simultaneous combination of both is currently the most cost-effective VTE prophylaxis regimens. The choice between them is best guided by the relative VTE and bleeding risks of individual patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A comparative cost-effectiveness analysis of mechanical and pharmacological VTE prophylaxis after lower limb arthroplasty in Australia

Torres

Saunders

2019

J Orthop Surg Res

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“…This is similar to other source validations conducted on other Australian clinical audits such as our Queensland counterparts who found an overall agreement of 98.2% 9 or the Victorian Cardiac Outcomes Registry, which found a 97.4% agreement between their data and hospital medical records. 14 It is noted that the use of TED stockings appears in the nursing notes rather than in the drug charts, as the task of prescribing deep venous thrombosis prophylaxis often falls to junior members of a clinical team 15 and the responsibility of completing the VASM audit falls upon the consultant surgeon. This may account for the instances where the external validator identified the use of TED stockings but the treating surgeon did not.…”

Section: Discussionmentioning

confidence: 99%

Validation of data submitted by the treating surgeon in the Victorian Audit of Surgical Mortality

Hansen

Retegan

et al. 2018

ANZ Journal of Surgery

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Background: The Victorian Audit of Surgical Mortality (VASM) seeks to peer review all deaths associated with surgical care in Victoria, Australia. The effectiveness of the VASM as an educational and quality improvement tool is dependent on the accuracy of source data it receives. We aimed to examine the accuracy and quality of source data provided by the treating surgeon for peer review, and the inter-rater concordance level between the external validator findings and the treating surgeon. Methods: Of the 629 cases that completed the VASM audit second-line peer review process over a 4-year period (from 1 July 2012 to 30 June 2016), a total of 32 (5%) were randomly selected for the external validation process. The blinded external validator was impartial to the VASM audit, and was provided only de-identified patient medical records. The analysis for the checked and validated data points and their concordance was determined using Gwet's agreement coefficient, which provides a stable inter-rater reliability coefficient not affected by prevalence and marginal probability. Results: The inter-rater concordance analysis suggested that there is a high level of agreement (82.9% overall) between the treating surgeon and external validator. The use of thromboembolism deterrent stockings was the only variable where agreement was poor (52.4%) with a Gwet score of 0.10 (−0.40 to 0.60). Conclusion: The inter-rater concordance analysis results support the validity of the VASM process, which is dependent on the accuracy of data submitted by the treating surgeon.

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“…Furthermore, it has negative financial consequences. All of this highlights the need for proper prevention 2 and treatment. VTE management requires a challenging risk assessment, 2 and measures which may be pharmacological, mechanical, surgical, or a combination.…”

Section: Introductionmentioning

confidence: 99%

Real world data on characteristics and management of community patients receiving anticoagulation therapy who presented with acute bleeding to the emergency department at a regional Australian hospital: A prospective observational study.

Hanna

Hyppa

Prakash³

et al. 2021

Mediterr J Hematol Infect Dis

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Objective: To study patients receiving anticoagulants with or without antiplatelet therapy presenting at a regional Australian hospital with bleeding. The main aims are to explore: (1) patients’ characteristics and management provided; (2) association between the type of anticoagulant and antiplatelet agent used and the requirement of reversal; (3) and the length of hospital stay (LoS) in conjunction with bleeding episode and management. Methods: A prospective cross-sectional review of medical records of all patients who presented at a tertiary referral centre with bleeding while receiving anticoagulation therapy between January 2016 and June 2018. Data included: demographics, investigations (kidney and liver function tests, coagulation profile, FBC), LoS, bleeding site, type of and reason for anticoagulation therapy, and management provided. Data analysis included descriptive statistics, ?2 association, and regression models. Results: Among the 144 eligible patients, 75 (52.1%) were male, and the mean age was 76 years (SD=11.1). Gastrointestinal tract bleeding was the most common (n=48, 33.3%), followed by epistaxis (n=32, 22.2%). Atrial fibrillation was the commonest reason for anticoagulation therapy (n=65, 45.1%). Warfarin was commonly used (n=74, 51.4%), followed by aspirin (n=29, 20.1%), rivaroxaban (n=26, 18.1%), and apixaban (n=12, 8.3%). A majority had increased blood urea nitrogen (n=67, 46.5%), while 58 (40.3%) had an elevated serum creatinine level, and 59 (41.0%) had a mild reduction in eGFR. Thirty-five of the warfarinised patients (47.3%) had an INR above the target range of their condition despite normal liver function. Severe anaemia (Hb<80g/L) was reported in 88 patients (61.1%). DOACs were associated with a reduced likelihood of receiving reversal (B= -1.7, P=<.001), and with a shorter LoS (B= -4.1, P=.046) when compared with warfarin, LMWH, and antiplatelet therapy. Conclusion: Warfarin use was common among patients who presented with acute bleeding, and the INR in many warfarinised patients exceeded the target for their condition. DOACs were associated with a reduced likelihood for receiving reversal and with a shorter LoS when compared to warfarin, LMWH, which might support wider application of DOACs into community practice.

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Current state of medical thromboprophylaxis in Australia

Cited by 3 publications

References 24 publications

A comparative cost-effectiveness analysis of mechanical and pharmacological VTE prophylaxis after lower limb arthroplasty in Australia

A comparative cost-effectiveness analysis of mechanical and pharmacological VTE prophylaxis after lower limb arthroplasty in Australia

Validation of data submitted by the treating surgeon in the Victorian Audit of Surgical Mortality

Real world data on characteristics and management of community patients receiving anticoagulation therapy who presented with acute bleeding to the emergency department at a regional Australian hospital: A prospective observational study.

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