Insufficient duration of venous thromboembolism prophylaxis after total hip or knee replacement when compared with the time course of thromboembolic events

Abstract

Patients who have undergone total hip or knee replacement (THR and TKR, respectively) are at high risk of venous thromboembolism. We aimed to determine the time courses of both the incidence of venous thromboembolism and effective prophylaxis. Patients with elective primary THR and TKR were enrolled in the multi-national Global Orthopaedic Registry. Data on the incidence of venous thromboembolism and prophylaxis were collected from 6639 THR and 8326 TKR patients. The cumulative incidence of venous thromboembolism within three months of surgery was 1.7% in the THR and 2.3% in the TKR patients. The mean times to venous thromboembolism were 21.5 days (sd 22.5) for THR, and 9.7 days (sd 14.1) for TKR. It occurred after the median time to discharge in 75% of the THR and 57% of the TKA patients who developed venous thromboembolism. Of those who received recommended forms of prophylaxis, approximately one-quarter (26% of THR and 27% of TKR patients) were not receiving it seven days after surgery, the minimum duration recommended at the time of the study. The risk of venous thromboembolism extends beyond the usual period of hospitalisation, while the duration of prophylaxis is often shorter than this. Practices should be re-assessed to ensure that patients receive appropriate durations of prophylaxis.

The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

“…[6,[8][9][10][11][12][13][14][15][16][17][18][19][20]26,37,41] A difficulty of long-term follow-up of patients is that many DVT events occur several weeks or longer after discharge. [37,42] …”

Incidence, Diagnosis, and Risk Factors of Venous Thromboembolism after Surgery for Malignant Bone and Soft Tissue Tumor of Lower Extremity

“…When we think about VTE prophylaxis, it is important to know which time point after surgery VTE is easy to occur at, or how we can diagnose VTE. It was reported that the onset of distal deep venous thromboembolism (DVT) was between 1 to 5 days [3] or 9.7 days [7] after surgery in total knee arthroplasty (TKA), 21.5 days [7] after surgery in total hip arthroplasty (THA), and 15.3 (median: 9.5) days after surgery in long spinal fusions [8]. Thus, the development time of VTE varies depending on surgical procedure (operative method or invasion).…”

Massive Pulmonary Embolism after Lumbar Spinal Fusion Surgery

“…Belirtilen farmakolojik ve mekanik tromboflaksi ile derin ven trombozu ve pulmoner emboli riskinin %0,1'lerin altına çekilebileceği bildirilmiştir (5,6).…”