Adherence to the international thromboprophylaxis guidelines in patients undergoing major orthopaedic surgery in Colombia: Results of the DEIMOS registry
DOI:
https://doi.org/10.1016/j.rccot.2020.02.007Keywords:
arthroplasty, femur fractures, thromboembolism, pulmonary embolism, clinical practice guidelines, primary preventionAbstract
Background: Patients who undergo major orthopaedic surgery have an elevated risk of venous thromboembolism (VTE). International guidelines recommendations for VTE prevention have shown to be effective in reducing the frequency of thromboembolic events, but compliance to these recommendations is still low. The purpose of the present study is to report the adherence to the American College of Chest Physicians (ACCP) guidelines 2008 in Colombia.
Material and methods: A report is presented on the Colombian results for the DEIMOS registry. This is a multinational, multicentre, observational, longitudinal study. Twenty orthopaedic wards were asked to include consecutive patients who were admitted for major orthopaedic surgery. Patient demographics, surgical information, type of anaesthesia and VTE prophylaxis were prospectively recorded, and the use of VTE prevention methods was assessed during the following visits. Adherence to the 2008 ACCP guidelines was then determined.
Results: A total of 244 patients were included in Colombia, and 240 of them had a complete follow-up. The analysis included 108 total knee arthroplasties, 77 hip replacements and 59 hip fracture surgeries. Adherence to 2008 ACCP guidelines for in-hospital prophylaxis was 80.5% (95% CI; 71.7-89.4) for hip arthroplasty, 82.4% (95% CI; 75.2-89.6) for knee arthroplasty, and 94.9% CI; 89.3-100.0) for hip fracture surgeries. Adherence for extended prophylaxis was 75.3% (95% CI; 65.7-85.0) for hip arthroplasties, 73.1% (95% CI; 64.8-81.5) for knee arthroplasties, and 93.2% (95% CI; 86.8-99.6) for hip fracture surgery.
Discussion: The DEIMOS registry reports good compliance to VTE prophylaxis guidelines after hip fracture surgery in Colombia. However, adherence to extended prophylaxis guidelines is still low after total hip and knee arthroplasties. Efforts should be made to improve the protection of these patients after hospital discharge.
Downloads
References
Geerts W, Pineo G, Heit J, Bergquist D, Lassen M, Colwell C, et al. Prevention of venous thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126:338S-400S, https://doi.org/10.1378/chest.126.3_suppl.338S
Lapidus LJ, Ponzer S, Pettersson H, de Bri E. Symptomatic venous thromboembolism and mortality in orthopaedic surgery - an observational study of 45 968 consecutive procedures. BMC Musculoskelet Disord. BMC Musculoskeletal Disorders;. 2013;14:177, https://doi.org/10.1186/1471-2474-14-177
Januel J, Chen G, Ruffieux C. Symptomatic In-Hospital Deep Vein Thrombosis and Pulmonary Embolism Following Hip and Knee Arthroplasty Among Patients Receiving Recommended Prophylaxis. A Systematic Review. J Am Med Assoc. 2012;307:294-303. https://doi.org/10.1001/jama.2011.2029
Schiff RL, Kahn SR, Shrier I, Strulovitch C, Cohen E, Zukor D. Identifying Orthopedic Patients at High Risk for Venous Thromboembolism Despite Thromboprophylaxis Identifying Orthopedic Patients at High Risk for Venous Thromboembolism Despite Thromboprophylaxis*. Chest. 2005;128:3364-71, https://doi.org/10.1378/chest.128.5.3364
White RH, Romano PS, Zhou H, Rodrigo J, Bargar W. Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty. Arch Intern Med. 1998;158:1525-31. https://doi.org/10.1001/archinte.158.14.1525
Hull RD, Pineo GF, Stein PD, Mah AF, MacIsaac SM, Dahl OE, et al. Extended out-of-hospital low-molecular-weight heparin prophylaxis against deep venous thrombosis in patients after elective hip arthroplasty: A systematic review. Ann Intern Med. 2001;135:858-69. https://doi.org/10.7326/0003-4819-135-10-200111200-00006
Kahn S, Shrier I, Julian J, Ducruet T, Arsenault L, Miron MJ, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med. 2008;149:698-707. https://doi.org/10.7326/0003-4819-149-10-200811180-00004
Pengo V, Lensing AW, Prins MH, Marchiori A, Davidson BL, Tiozzo F, et al. Incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism. N Engl J Med. 2004;350:2257-64, https://doi.org/10.1056/NEJMoa032274
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008 Jun;133 6 Suppl:381S-453S, https://doi.org/10.1378/chest.08-0656
National Institute for Health and Clinical Excellence. Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary emboism) in patients admitted to hospital. 2010;.(NICE clinical guideline 92).
Nicolaides A, Fareed J, Kakkar A, Comerota A, Goldhaber S, Hull R, et al. Prevention and treatment of venous thromboembolism. International Consensus Statement. Int Angiol. 2013;32:111-260.
Bergqvist D, Arcelus JI, Felicissimo P. Evaluation of the duration of thromboembolic prophylaxis after high-risk orthopaedic surgery: The ETHOS observational study. Thromb Haemost. 2012;107:270-9, https://doi.org/10.1160/TH11-07-0463
Arcelus JI, Felicissimo P. Venous thromboprophylaxis duration and adherence to international guidelines in patients undergoing major orthopaedic surgery: Results of the international, longitudinal, observational DEIMOS registry. Thromb Res. 2013;131:e240-6, https://doi.org/10.1016/j.thromres.2013.03.014
Dennis RJ, Roa JH, Villadiego J, Méndez F, Vieda E, Restrepo H. Profilaxis de la tromboembolia venosa en pacientes colombianos de tratamiento médico o quirúrgico: resultados para Colombia del estudio ENDORSE. Biomedica. 2011;31:200-8. https://doi.org/10.7705/biomedica.v31i2.304
Cohen AT, Tapson VF, Bergmann J-F, Goldhaber SZ, Kakkar AK, Deslandes B, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008 Feb 2;371:387-94, https://doi.org/10.1016/S0140-6736(08)60202-0
Friedman R, Gallus A, Cushner F, FitzGerald G, Frederick A. Physician compliance with guidelines for deep-vein thrombosis prevention in total hip and knee arthroplasty. Curr Med Res Opin. 2008;24:87-97. https://doi.org/10.1185/030079907X242746
Llinás A, Gonzalez J, Mieth K, Ruiz A. Recomendaciones del primer consenso colombiano de enfermedad tromboembolica en cirugia ortopédica mayor de pelvis, cadera y rodilla. Rev Col Or Tra. 1998;12:3-52.
