Prevention of venous thromboembolism after total hip and knee arthroplasties in Australian hospitals: what are we using?

IF 1 Q4 PHARMACOLOGY & PHARMACY

Journal of Pharmacy Practice and Research Pub Date : 2024-05-21 DOI:10.1002/jppr.1919

Nameer van Oosterom BPharm (Hon), PhD, Michael Barras PhD, Neil Cottrell PhD

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引用次数: 0

Abstract

Background

Venous thromboembolism (VTE) is a leading cause of preventable morbidity and mortality, with total hip arthroplasty (THA) and total knee arthroplasty (TKA) at the highest risk. Safe and appropriate thromboprophylaxis is essential. However, investigations into prescribing practices have been limited.

Aim

To describe current VTE prophylaxis regimens in Australian patients following an elective THA/TKA and compare these regimens to an international standard.

Method

A retrospective multisite case series of patients admitted for a THA/TKA in six tertiary hospitals in Queensland, Australia, was conducted over 12 months (1 October 2017–30 September 2018). Patient and medication data were collected following surgery and for 60 days after discharge to determine changes to the patients' thromboprophylaxis regimen. Results were summarised and compared to National Institute for Health and Care Excellence (NICE) guidelines. Ethical approval was granted by the Metro South Human Research Ethics Committee (Reference no: HREC/2018/QMD/46757) and the study conforms to the National Statement on Ethical Conduct in Human Research.

Results

The study included 1011 patients (43.1% THA, 56.9% TKA), and thromboprophylaxis was used in 98.1% of inpatients and in 94.3% of discharge patients for 5.2 (±5.2) and 29.2 (±15.9) days (±standard deviation) respectively. Low-molecular-weight heparins (LMWHs) were the primary drugs for inpatients (71.2%) and aspirin 150 mg for discharge (42.0%), most commonly for 6 weeks (31.8%). Aspirin was used for significantly longer duration than rivaroxaban and LMWH (p < 0.001). A two-staged prophylaxis regimen was implemented, most commonly any anticoagulant as an inpatient; followed by rivaroxaban on discharge (32.7%) or an anticoagulant as an inpatient with aspirin on discharge (26.4%). Overall, adherence to NICE guidelines was low; THA: 8.7%, TKA: 5.9%.

Conclusion

VTE prophylaxis regimens varied considerably, and consequently, adherence to international guidelines was low. There is a need for local, peer-led guidelines to ensure consistent, safe, and effective prophylaxis.

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澳大利亚医院全髋关节和膝关节置换术后的静脉血栓栓塞预防：我们在用什么？

静脉血栓栓塞症（VTE）是可预防的发病率和死亡率的主要原因，其中全髋关节置换术（THA）和全膝关节置换术（TKA）的风险最高。安全、适当的血栓预防至关重要。为了描述澳大利亚患者在接受择期 THA/TKA 术后的 VTE 预防方案，并将这些方案与国际标准进行比较，我们在 12 个月内（2017 年 10 月 1 日至 2018 年 9 月 30 日）对澳大利亚昆士兰州 6 家三级医院接受 THA/TKA 术的患者进行了回顾性多地点病例系列研究。收集了手术后和出院后 60 天内的患者和用药数据，以确定患者血栓预防方案的变化。对结果进行总结，并与美国国家健康与护理优化研究所（NICE）指南进行比较。该研究纳入了1011名患者（43.1% THA，56.9% TKA），98.1%的住院患者和94.3%的出院患者分别在5.2（±5.2）天（±标准偏差）和29.2（±15.9）天（±标准偏差）内使用了血栓预防疗法。住院患者的主要药物是低分子量肝素（LMWHs）（71.2%），出院患者的主要药物是阿司匹林 150 毫克（42.0%），最常用的药物是阿司匹林 6 周（31.8%）。阿司匹林的使用时间明显长于利伐沙班和 LMWH（P < 0.001）。预防方案分为两个阶段，最常见的是住院时使用任何抗凝剂；随后在出院时使用利伐沙班（32.7%）或住院时使用抗凝剂，出院时使用阿司匹林（26.4%）。总体而言，NICE指南的依从性较低；THA：8.7%，TKA：5.9%.VTE预防方案差异很大，因此国际指南的依从性也很低。有必要制定由当地同行主导的指南，以确保采取一致、安全和有效的预防措施。

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来源期刊

Journal of Pharmacy Practice and Research Health Professions-Pharmacy

CiteScore

1.60

自引率

9.50%

发文量

期刊介绍： The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.