Venous Thromboembolism: Management by American Association of Hip and Knee Surgeons

doi:10.1016/j.arth.2009.07.021

The Journal of Arthroplasty

Volume 25, Issue 1, January 2010, Pages 3-9.e2

https://doi.org/10.1016/j.arth.2009.07.021 Get rights and content

Abstract

A 2008 survey of American Association of Hip and Knee Surgeons membership explored current venous thromboembolism (VTE) protocols for lower-extremity total joint surgery. Fifty-three percent reported a change in VTE-related practices in the last 5 years. More than 70% reported that their primary hospital now mandates VTE prophylaxis. Although 74% of their primary hospitals recognized the American College of Chest Physicians guidelines, 68% of surgeons felt the American Academy of Orthopaedic Surgeons guidelines were more relevant to their practice. Respondents believe low molecular weight heparin to be the most efficacious but aspirin to be the easiest to use and has the lowest risks of bleeding and wound drainage. Warfarin was the most used in hospital prophylaxis, and 90% of respondents targeted an international normalized ratio of 1.6 to 2.5. Practice patterns continue to evolve, and there remains no consensus on specific treatment protocols or preferences.

Section snippets

Materials and Methods

A 5-stage mixed mode (fax/e-mail) survey of all active AAHKS members (n = 840) was conducted between May and June 2008, using Dillman's [4] survey research methods. Human subject criteria were used in the questionnaire development, survey distribution, and data management stages to protect the anonymity and confidentiality of the AAHKS members. The survey was developed and approved by the AAHKS Research Committee. Dillman's [4] survey sample size formula was used to determine the minimum number

Preoperative VTE Screening and Prophylaxis

Most of the surgeons (86%, 376/437) screened for VTE preoperatively. The most common screening process was an evaluation of the preoperative history (83%, 384/465), followed by a risk assessment tool (13%, 61/465). When asked which risk factors for VTE modified their VTE prophylaxis, 86% (399/465) stated that a previous history of VTE was important. Other important factors were cancer history (36%, 168/465), obesity (34%, 158/465), and a family history of VTE (16%, 72/465) (Fig. 2).

Regarding

Discussion

Many aspects of VTE prophylaxis remain controversial among orthopedic surgeons. By examining the survey responses of this large group of high-volume total joint surgeons, insight is provided relative to practice patterns, standards of care, the impact of national guidelines, and use of newer pharmacologic materials. In addition, the changes that have occurred in the aforementioned areas can be juxtaposed to the findings of the 2000 AAHKS survey data.

In 1974, Simon and Stengle [5] published a

Acknowledgments

We thank the AAHKS members for returning their surveys and supporting their organization. Assistance with survey distribution, electronic data entry, and data management was provided by Heidi Schmalz, Manager of Survey Research, Department of Research and Scientific Affairs, at the American Academy of Orthopaedic Surgeons.

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Optimum venous thromboembolism (VTE) prophylaxis for patients undergoing total hip or knee arthroplasty remains undefined. The purpose of this study is to compare complication rates among total joint arthroplasty patients using either low-dose aspirin (75 mg once daily) or low-molecular-weight heparin (LMWH; Fragmin/dalteparin 5000 U) for VTE prophylaxis.
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: No benefits or funds were received in support of the study.

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