Estimating the Incidence of Symptomatic Postoperative Venous Thromboembolism

Heit, John A.

doi:10.1001/jama.2011.2013

Cited by 23 publications

(12 citation statements)

References 8 publications

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“…By 2007, the payment structure from CMS transitioned to ''pay for performance,'' prompting many hospitals to implement the SCIP measures and comply with TJC surveys and National Quality Forum endorsed measures [8,24]. Although SCIP VTE prophylaxis adherence rates have improved, there are limited data showing that adherence reduces VTE event rates [24][25][26].…”

Section: Surgical Care Improvement Projectsmentioning

confidence: 99%

“…Controversy has emerged surrounding the incidence of post-operative VTE, the appropriate duration for observation, and the level of surveillance applied to detect events [25][26][27]. The in-hospital rates of VTE in patients receiving appropriate thromboprophylaxis after hip and knee arthroplasty were estimated recently at approximately 0.5 and 1 % of patients, respectively [25].…”

Section: Surgical Care Improvement Projectsmentioning

confidence: 99%

“…However, SCIP VTE events are based on the accurate presence of International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) hospital discharge codes whose accuracy has been challenged [28]. Furthermore, the period of post-op VTE risk extends well beyond hospitalization in hip (10-12 weeks) and knee arthroplasty (4-6 weeks) [26]. Three month VTE incidence rates reflect the longer period of VTE risk and may be a more appropriate observational period for quality improvement measures.…”

Section: Surgical Care Improvement Projectsmentioning

confidence: 99%

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Regulatory, legislative, and policy updates with anticoagulant use

Fanikos

Buckley

Aldemerdash

et al. 2015

J Thromb Thrombolysis

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Thromboembolism afflicts millions of patients annually in the United States and is associated with a significant cost burden. Recent advances in oral anticoagulation have provided clinicians with more options for management of these diseases. Accordingly, regulatory, legislative, and policy-making organizations have intervened with the aim of improving patient outcomes, ensuring patient safety, and reducing costs. There have been a number of recent developments in surveillance, litigation, and regulatory oversight that clinicians should recognize. In this review article we summarize key updates related to the management of anticoagulant therapy as it relates to thrombosis prevention and treatment.

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Section: Surgical Care Improvement Projectsmentioning

confidence: 99%

Section: Surgical Care Improvement Projectsmentioning

confidence: 99%

Section: Surgical Care Improvement Projectsmentioning

confidence: 99%

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Regulatory, legislative, and policy updates with anticoagulant use

Fanikos

Buckley

Aldemerdash

et al. 2015

J Thromb Thrombolysis

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“…Equally, it has been argued that the rates of symptomatic VTE in Januel's recent meta-analysis are underestimated because of the mandatory screening involved, relatively short follow-up periods, and the lack of generalizability to real-world patients. 13 In view of the inconsistencies and limitations of the current dataset, as well as the rapidly changing face of clinical practice stemming from the profusion of new oral pharmacological agents, it is clear that additional real-world studies of VTE in orthopedic surgery are required. The next section provides examples of two current initiatives involving registry-based data.…”

Section: Risk Of Vte In Orthopedic Surgerymentioning

confidence: 99%

Update on thromboprophylaxis in orthopedic surgery and critical appraisal of the role of enoxaparin

Wong¹,

Loke²

2012

ORR

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Orthopedic surgery is considered one of the most prominent risk factors for venous thromboembolism (VTE), but the optimal strategy for thromboprophylaxis remains a debatable topic. Consistent and reliable definitions of clinically relevant VTE and major bleeds in orthopedic research are particularly contentious areas, resulting in uncertainty about the actual benefit-harm balance of available interventions. For the newer oral anticoagulants, short-term clinical trials in highly selected patients with asymptomatic VTE (from mandatory radiological screening) must be supplemented by long-term efficacy and safety data in real-world settings (such as the Global Orthopedic Registry). The evidence gap leads to visible differences among recent recommendations from bodies such as the American College of Chest Physicians (2012), the American Academy of Orthopedic Surgeons (2011), and the National Institute of Clinical Excellence, England (NICE, 2012). While thromboprophylaxis after hip and knee arthroplasty is clearly recommended by all three bodies, there is no consistent agreement on the optimal agent or the duration of prophylaxis. Differences in opinion stem from subjective judgments on the relative weighting given to asymptomatic as opposed to symptomatic VTE, and the impact of major bleeding. While the newer oral anticoagulants (such as rivaroxaban and apixaban) seem to offer significant benefits compared to enoxaparin in the reduction of asymptomatic VTE, the data are limited by the paucity of symptomatic VTE and inconsistencies in capturing major bleeds. The lack of long-term experience in real world patients means that it is too early to judge whether the obvious convenience of newer oral anticoagulants will result in better patient adherence, safety, and quality of life as compared to enoxaparin. Further research should focus on clinically relevant outcomes, with clear definitions of bleeding, so that the benefit-harm trade-offs related to the diverse agents can be assessed through methods such as multiple treatment comparison meta-analysis.

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“…Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, represents a serious, and on occasion fatal, complication of surgery [1,2]. Because randomized trials suggest that mechanical thromboprophylaxis may prevent postoperative VTE, and because they do not incur the bleeding risk associated with pharmacologic prophylaxis, clinical practice guidelines often recommend use of mechanical thromboprophylaxis after surgery [1,3].…”

Section: Introductionmentioning

confidence: 99%