Venous thromboembolism prevention protocol for adapting prophylaxis recommendations to the potential risk post total knee replacement: a randomized controlled trial

Abstract

Background: Total knee replacement (TKR) is a major orthopedic surgery that is considered high risk for the development of venous thromboembolism (VTE).
 Objective: The aim of this study is to evaluate the clinical outcomes that resulted from the use of a new proposed VTE risk stratification protocol for selecting a suitable extended VTE prophylaxis for post TKR surgery patients administered in conjunction with patient education programs.
 Method: A randomized controlled trial was conducted in two medical centers in Saudi Arabia. A total of 242 patients were enrolled in the study, 121 patients in each group. The experimental group (A) was assessed by using the proposed VTE risk stratification protocol and also took part in patient education programs about TKR and its complications. The control group (B) was assessed by using the 2005 Caprini risk assessment tool and no education programs were given to this group. Both groups were followed for 35 days post operation.
 Results: The mean age of the participants was 65.86 (SD 8.67) and the majority of them were female 137 (56.6%). The mean body mass index of the study sample was 32.46 (SD 5.51). There were no significant differences between the two groups except for surgery type; the proportion of bilateral TKR in group A was higher than in group B (69/121 (28.5%) vs. 40/121(16.5%), p˂0.05). There were no confirmed pulmonary embolism cases in the study sample and diagnosis of deep-vein thrombosis was confirmed in 12/242 (5.0%) of patients: 1/121 (0.8%) in group A and 11/121 (9.1%) in group B (p˂0.05). The readmission rate for all patients was 2.5% (6/242), all of whom were in group B (p˂0.05).
 Conclusion: The proposed VTE risk stratification protocol that was applied in conjunction with patient education programs reduced VTE complications and readmission events, post TKR surgery.
 Trial Registration: ClinicalTrials.gov Identifier: NCT04031859.

Current status survey of the extramural hospital management of venous thromboembolism after total hip and knee arthroplasty in China

“…Implementing a multi-mode approach to venous thromboembolism prevention and a rapid recovery plan is beneficial to reducing the incidence of VTE [6,29]. Patient educational programmes performed by clinical pharmacists have added a synergistic effect to decrease the risk of VTE [11]. Our findings may show that the current recommendations for VTE prophylaxis are adequate for preventing VTE in hospitals but inadequate after discharge.…”

“…Reasonable and practical preventive measures and long-term management are essential means to prevent VTE [10]. Many studies on clinical guidelines for VTE prophylaxis are intended to assess the management of patients undergoing THA/TKA in the hospital [1,3,11]. However, there are quite a few VTEs that occur in outpatients after surgery.…”

“…Patients at home may often face this situation of no supervision by doctors or nurses in time. Thus, the misunderstanding of VTE disease, unawareness of therapy importance, and low compliance may result in higher incidences of VTE [11].…”