Post-discharge venous thromboembolism prophylaxis for surgical oncology patients.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 79-79
Author(s):  
Ashlie Nadler ◽  
Mary Ellen Morba ◽  
Jesse Pezzella ◽  
Jeffrey M. Farma
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Compliance Rate ◽  
Surgical Oncology ◽  
Pelvic Surgery ◽  
Cancer Center ◽  
Thromboembolism Prophylaxis ◽  
Post Discharge ◽  
Oncology Patients ◽  
Vte Prophylaxis

79 Background: A number of guidelines have been proposed for prolonged venous thromboembolism (VTE) prophylaxis following hospital discharge for cancer patients undergoing major abdominal or pelvic surgery. However, there is disparity in how closely these guidelines are followed. The purpose of this study was to examine the administration and complications of post-discharge chemical VTE prophylaxis (pdVTE) at an institutional level among surgical oncology patients to help inform policy creation. Methods: A retrospective study at a tertiary referral cancer center was performed. Data was analyzed for patients undergoing surgery in 2015. Chi-square tests were performed. Results: Of 566 colorectal, urologic, and gynecologic surgical oncology procedures performed in 2015, 24% (137) were discharged with a prescription for enoxaparin for pdVTE. An additional 24 patients were already on another form of anticoagulation at the time of discharge. Of the patients discharged on pdVTE, 77% (105) had the prescriptions filled. The compliance rate of those patients was 96% (101). The rate of VTE was 3.5% for all patients. There was a significantly greater rate of VTE amongst patients that received pdVTE (10.4%) compared to those who did not (1.6%) (OR 7.20, CI 2.80-18.46, p < 0.001). For each subspecialty, there was also a significantly greater rate of VTE amongst patients that received pdVTE (p < 0.001). Conclusions: There is a very low rate of pdVTE administration despite current guidelines. Identifying patients who received pdVTE appears to identify patients at high risk for VTE rather than the benefits of pdVTE. Institutional policies regarding prolonged VTE prophylaxis should be implemented to target high-risk patients and to ensure appropriate prescribing practices. [Table: see text]

Implementation of extended prolonged venous thromboembolism prophylaxis with rivaroxaban after major abdominal and pelvic surgery safety and early outcomes.

2020 ◽  
Vol 92 (5) ◽  
pp. 1-5
Author(s):  
Volodymyr Tyselskyi ◽  
Vitaliy Poylin ◽  
Daniel Wong ◽  
Yegor Tryliskyy ◽  
Andrey Kebkalo
Keyword(s):  
Venous Thromboembolism ◽  
Colorectal Surgery ◽  
Factor Xa ◽  
Pelvic Surgery ◽  
Minor Bleeding ◽  
Thromboembolism Prophylaxis ◽  
Post Discharge ◽  
Vte Prophylaxis ◽  
Abdominal Bleeding ◽  
Patient Reported

Abstract Purpose: Venous thromboembolism (VTE) after colorectal surgery is a well-documented complication, resulting in a general recommendation of extended post discharge prophylaxis. Rivaroxaban, a factor Xa inhibitor, is a daily tablet approved for treatment of VTE and prophylaxis after orthopedic surgery. The purpose of this study is to evaluate the safety of rivaroxaban for extended prophylaxis after major abdominal and pelvic surgery. Methods: This is a retrospective review of patients undergoing major colorectal surgery at a regional hospital in Kiev, Ukraine. Patients received peri-operative VTE prophylaxis with subcutaneous heparin and then transitioned to rivaroxaban for a total of 30 days. Occurrences of major or minor bleeding, blood transfusion, and a need for re-intervention were noted. Phone surveys were administered on post-operative day 30 to assess compliance and satisfaction with the regimen. Results A total of 51 patients were included in the study with an average age of 62.4 years old. Seventy-one percent of the cases were abdominal cases, 29% were pelvic cases and 59% were done laparoscopically. There was one episode of major intra-abdominal bleeding requiring return to the operating room. There were 2 minor bleeding episodes not requiring intervention. There were no VTE events in the group. The phone survey response rate was 100%. All but one patient reported completing the full course of rivaroxaban. Patients reported that oral prophylaxis was easy to adhere to and preferable compared to injections. Conclusion Implementation of extended prophylaxis with rivaroxaban is easy, safe and does not increase rates of post-operative bleeding.

Post-discharge compliance to venous thromboembolism prophylaxis in high-risk orthopaedic surgery

2012 ◽  
Vol 107 (02) ◽  
pp. 280-287 ◽  
Author(s):  
Juan Arcelus ◽  
Paulo Felicissimo ◽  
David Bergqvist ◽  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Patient Education ◽  
Patient Compliance ◽  
Orthopaedic Surgery ◽  
Thromboembolism Prophylaxis ◽  
Post Discharge ◽  
Access To Treatment ◽  
Good Compliance ◽  
Vte Prophylaxis

SummaryVenous thromboembolism (VTE) risk persists for several weeks following high-risk orthopaedic surgery (HROS). The ETHOS registry evaluated post-operative VTE prophylaxis prescribed, and actual VTE prophylaxis received, compared with the 2004 American College of Chest Physicians (ACCP) guidelines in HROS patients. We performed a subanalysis of ETHOS to assess patient compliance with ACCP-adherent prophylaxis after discharge and the factors predicting poor compliance. Consecutive patients undergoing hip fracture surgery, total hip arthroplasty, or knee arthroplasty were enrolled at discharge from 161 centres in 17 European countries if they had received adequate in-hospital VTE prophylaxis. Data on prescribed and actual prophylaxis received were obtained from hospital charts and patient post-discharge diaries. Good compliance was defined as percentage treatment intake ≥80% with no more than two consecutive days without treatment. A total of 3,484 patients (79.4%) received ACCP-adherent anticoagulant prescription at discharge and 2,999 (86.0%) had an evaluable patient diary. In total, 87.7% of evaluable patients were compliant with prescribed treatment after discharge. The most common reason for non-compliance (33.4%) was “drug was not bought”. Injection of treatment was not a barrier to good compliance. Main factors affecting compliance related to purchase of and access to treatment, patient education, the person responsible for administering injections, country, and type of hospital ward at discharge. Within our study population, patient compliance with ACCP-adherent thromboprophylaxis prescribed at discharge was good. Improvements in patient education and prescribing practices at discharge may be important in further raising compliance levels in high-risk orthopaedic surgery patients.

scholarly journals Extended venous thromboembolism prophylaxis after abdominopelvic cancer surgery: a retrospective review

2019 ◽  
Vol 26 (1) ◽  
Author(s):  
M. Laureano ◽  
M. Ebraheem ◽  
M. Crowther
Keyword(s):  
Venous Thromboembolism ◽  
Tertiary Care ◽  
Transitional Cell ◽  
Cancer Surgery ◽  
Pelvic Surgery ◽  
Serous Carcinoma ◽  
Guideline Recommendation ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
Pelvic Cancer

Objective Extended prophylaxis against venous thromboembolism (vte) after abdominal or pelvic cancer surgery with low molecular weight heparin (lmwh) is recommended by multiple guidelines. The primary objective of the present study was to assess adherence to that guideline recommendation at tertiary care centres within Hamilton Health Sciences (hhs).Methods Given that an estimated 70% of the study population would be expected to receive extended prophylaxis, a sample size of 105 patients was calculated. Patients who had undergone abdominal or pelvic surgery for cancer from March 2012 to December 2015 were identified, and data were collected from electronic health records. The primary outcome was prescription of extended vte prophylaxis.Results Of 105 patients, only 3 received extended vte prophylaxis. Those 3 patients had serous carcinoma of the uterus, transitional cell carcinoma of the bladder, and cecal cancer. Of the 3 patients, 2 were followed by the thrombosis service while in hospital; none of the other 102 patients received any form of extended vte prophylaxis.Conclusions Based on multiple randomized controlled trials, guidelines suggest lmwh prophylaxis for up to 4 weeks after major abdominal or pelvic cancer surgery. Despite those recommendations, postoperative extended vte prophylaxis is not commonly prescribed at hhs facilities. Next steps will include identification of barriers and an examination of how those barriers could be addressed. Failure to use prophylaxis is not consistent with evidencebased guidelines and is placing patients at risk of vte.

scholarly journals Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update 2014

2015 ◽  
Vol 33 (6) ◽  
pp. 654-656 ◽  
Author(s):  
Gary H. Lyman ◽  
Kari Bohlke ◽  
Alok A. Khorana ◽  
Nicole M. Kuderer ◽  
Agnes Y. Lee ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Oral Anticoagulants ◽  
Signs And Symptoms ◽  
Pelvic Surgery ◽  
Cochrane Library ◽  
Major Surgery ◽  
Thromboembolism Prophylaxis ◽  
Patients With Cancer

Purpose To provide current recommendations about the prophylaxis and treatment of venous thromboembolism (VTE) in patients with cancer. Methods PubMed and the Cochrane Library were searched for randomized controlled trials, systematic reviews, meta-analyses, and clinical practice guidelines from November 2012 through July 2014. An update committee reviewed the identified abstracts. Results Of the 53 publications identified and reviewed, none prompted a change in the 2013 recommendations. Recommendations Most hospitalized patients with active cancer require thromboprophylaxis throughout hospitalization. Routine thromboprophylaxis is not recommended for patients with cancer in the outpatient setting. It may be considered for selected high-risk patients. Patients with multiple myeloma receiving antiangiogenesis agents with chemotherapy and/or dexamethasone should receive prophylaxis with either low–molecular weight heparin (LMWH) or low-dose aspirin. Patients undergoing major surgery should receive prophylaxis starting before surgery and continuing for at least 7 to 10 days. Extending prophylaxis up to 4 weeks should be considered in those undergoing major abdominal or pelvic surgery with high-risk features. LMWH is recommended for the initial 5 to 10 days of treatment for deep vein thrombosis and pulmonary embolism as well as for long-term secondary prophylaxis (at least 6 months). Use of novel oral anticoagulants is not currently recommended for patients with malignancy and VTE because of limited data in patients with cancer. Anticoagulation should not be used to extend survival of patients with cancer in the absence of other indications. Patients with cancer should be periodically assessed for VTE risk. Oncology professionals should educate patients about the signs and symptoms of VTE.

scholarly journals Quality Improvement at an Academic Cancer Center: Venous Thromboembolism Prophylaxis in Patients With Multiple Myeloma

2020 ◽  
Vol 27 (2) ◽  
pp. 107327482093020
Author(s):  
Rachid Baz ◽  
Roy Furman ◽  
Katherine Simondsen ◽  
Christine Stone
Keyword(s):  
Multiple Myeloma ◽  
Quality Improvement ◽  
Venous Thromboembolism ◽  
Patient Education ◽  
Tertiary Care ◽  
Cancer Center ◽  
Prior History ◽  
Thromboembolism Prophylaxis ◽  
Practice Improvement ◽  
Vte Prophylaxis

Patients with multiple myeloma are at elevated risk of venous thromboembolism (VTE), the second leading cause of death in patients with cancer, but physician adherence to VTE prevention guidelines is low. Several organizations partnered in designing and implementing a 2-year quality improvement (QI) program in a tertiary care/academic cancer center, to increase awareness of VTE prophylaxis for patients with multiple myeloma and thus improve adherence to prophylaxis guidelines and protocols. The QI arm included 2 chart audits, conducted 2 years apart, of unmatched cohorts of 100 patients with multiple myeloma. An Education arm included 2 grand rounds presentations, 3 web-based case discussions, and a patient education module. Twenty providers took part in the continuous QI arm. More than 1100 learners participated in the online cases; the patient education curriculum reached 112 multiple myeloma patients. The initiative proved helpful in defining barriers to guideline adherence and identifying data-driven practice improvement strategies for VTE prophylaxis. It also increased learner awareness of VTE guidelines, patient risk stratification, and optimal thromboprophylaxis strategies. There was a reduction in VTE events (primary clinical outcome) from 10% at baseline to 4% in the follow-up cohort, although this was not statistically significant. Higher rates of guideline-based prophylaxis were observed in low-risk patients, and a lower incidence of VTE was observed in multiple myeloma patients with a prior history of VTE. Additional research is needed to refine prophylaxis guidelines. With appropriate institutional support, this type of QI program can be readily adopted by other organizations to address practice improvement needs.

Abstract P36: Venous Thromboembolism Prophylaxis in Hospitalized Medically Ill Patients

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Trudy Pendergraft ◽  
Montserrat Vera-Llonch ◽  
Alex Kartashov ◽  
Xianchen C Liu ◽  
Hemant Phatak ◽  
...  
Keyword(s):  
High Risk ◽  
Venous Catheter ◽  
Intermittent Pneumatic Compression ◽  
Nursing Home Admission ◽  
Thromboembolism Prophylaxis ◽  
Post Discharge ◽  
Vte Prophylaxis ◽  
Medically Ill ◽  
C Statistic ◽  
Medically Ill Patients

Background: Many hospitalized medically ill patients are at risk of VTE, during admission and after discharge. Risk factors include prior VTE, older age, immobility, obesity, heart or respiratory failure, and cancer. ACCP guidelines recommend use of low-molecular weight heparin (LMWH) or unfractionated heparin (UFH), and mechanical prophylaxis otherwise, in high-risk patients. VTE prophylaxis may be underutilized, however. Methods: Using a database linking admission records from >150 US hospitals to health insurance claims, we identified all persons, aged >=40 years, hospitalized from 2003 to 2008 and at high risk of VTE (based on ACCP guidelines). We excluded patients who: (1) underwent surgery; (2) were hospitalized in prior 30 days; (3) were treated for VTE in prior 30 days; (4) had hypercoagulability at admission; and (5) received LMWH, UFH, or fondaparinux (FOND) at therapeutic dosages on hospital day 1 or 2. We examined use of VTE prophylaxis during hospital admission and post-discharge. Results: We identified 35,606 patients who met all study entry criteria. Mean age was 67 years. Only 17.9% of study subjects received in-hospital VTE prophylaxis, most frequently LMWH (10.1%), intermittent pneumatic compression (4.5%), warfarin (2.9%), and/or stockings (2.0%). Prophylaxis use exceeded 25% only in patients with history (>30 days) of VTE and those admitted from nursing homes. Very few patients (1.7%) received post-discharge VTE prophylaxis; use was limited to LMWH. While there were several significant predictors of VTE prophylaxis (nursing home admission [odds ratio, 2.15; 95% confidence interval 1.91-2.42], central venous catheter placement [1.76; 1.60-1.94], ischemic stroke [1.68; 1.54-1.84] obesity [1.58; 1.47-1.70], and prior VTE [1.57; 1.24-1.99]), model discrimination was relatively poor (c statistic = 0.61). Conclusion: VTE prophylaxis is under-utilized in high-risk hospitalized medically ill patients, during initial admission and following hospital discharge.

512 Single Center Experience with Venous Thromboembolism Prophylaxis for Obese Burn Patients

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S93-S93
Author(s):  
Brian McKinzie ◽  
Rabia Nizamani ◽  
Samuel W Jones ◽  
Felicia N Williams
Keyword(s):  
Body Weight ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Peak Plasma ◽  
Total Body Surface Area ◽  
Retrospective Chart Review ◽  
Burn Patients ◽  
Thromboembolic Complications ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis

Abstract Introduction Burn injured patients are at high risk of thromboembolic complications. Morbid obesity further increases risk for thromboembolic complications. Recent evidence supports the use of anti-Xa guided enoxaparin dosing for the prevention of venous thromboembolism (VTE) in high risk populations. Our objective was to evaluate the efficacy of enoxaparin 40mg twice daily in achieving prophylactic plasma anti-Xa levels in obese burn patients. Methods A retrospective chart review of an ABA-verified burn center from November 2018 until September 2019 identified patients who were either ≥100 kilograms (kg) or had a body mass index (BMI) ≥ 30 kg/m2 and were initiated on enoxaparin 40 mg twice daily for VTE prophylaxis. Patients were included if they were at least 18 years of age and received at least three sequential doses of enoxaparin with appropriately timed peak plasma anti-Xa levels to monitor efficacy. Patient demographics were analyzed, as well as body weight, BMI, and total body surface area (TBSA) burn. Statistical analysis was performed with student’s t-test for continuous data and Fischer’s exact test for categorical data. Results During the study period, 148 patients were screened with 44 patients included for analysis. Forty-one percent of the patients evaluated did not reach target peak plasma anti-Xa levels (0.2–0.5 IU/mL) on enoxaparin 40 mg twice daily. Patients who did not meet prophylactic target levels were more likely to be male (p&lt; 0.05) and have an increased body weight (129 +/- 24 kg versus 112 +/- 17 kg, p&lt; 0.05). Eleven out of 18 patients received dosage adjustments with subsequent anti-Xa levels available for follow-up assessment, of which an additional four patients required further dosage adjustment to meet goal peak plasma levels. Conclusions Current utilization of a fixed 40 mg twice daily regimen of enoxaparin for VTE prophylaxis is inadequate to meet target prophylactic peak plasma anti-Xa levels in the obese burn patient population. Dose adjusting enoxaparin to target peak plasma anti-Xa levels to reduce VTE rates in obese burn patients should be further evaluated. Applicability of Research to Practice This study demonstrates the need for more accurate dosing and evaluation of our dosing practices for VTE prevention. It also demonstrates the importance of having a Burn dedicated pharmacist in facilitating appropriate care.

Rates of venous thromboembolism occurrence in medical patients among the insured population

2009 ◽  
Vol 102 (11) ◽  
pp. 951-957 ◽  
Author(s):  
Mohamed Hussein ◽  
Jay Lin ◽  
David Battleman ◽  
Alex Spyropoulos
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Multivariate Logistic Regression Analysis ◽  
The United States ◽  
Primary Diagnosis ◽  
Severe Form ◽  
World Population ◽  
Medical Patients ◽  
Post Discharge ◽  
Vte Prophylaxis

SummaryThe burden of venous thromboembolism (VTE) remains high in the United States (US). This study assesses the rate of VTE prophylaxis in a large real-world population of medically ill patients and identifies factors which confer VTE risk to this population. Discharges from the PharMetrics database were included if they were aged ≥40 years and had a hospitalisation claim (Jan 2001-Dec 2005) for cancer, congestive heart failure (CHF), severe infectious disease (SID), or lung disease. Discharges with incomplete records in the prior year to the index hospitalisation claim date were excluded. VTE rate, type (deep venous thrombosis [DVT] or pulmonary embolism [PE]), and time to VTE were compared between groups. Multivariate logistic regression analysis was used to identify independent predictors of VTE occurrence. A total of 158,325 patients were included in the study. Cancer patients had the highest incidence of VTE (7.6%), with the average for all patients being 5.6% (1.5% PE).VTE occurred most frequently post discharge, with the median time being 74 days. Post-discharge prophylaxis was provided to 13.1% of CHF patients and < 5% of all other patients. Independent predictors of VTE included a pre-index VTE (odds ratio [OR] 9.06, 95% confidence interval [CI] 8.28–9.91) and a primary diagnosis of cancer compared with a diagnosis of SID (OR 1.34, 95% CI 1.24–1.46). In conclusion, commercially insured medical patients in the US are at high risk of VTE following hospital discharge. One-quarter of medical patients who developed a VTE are at high risk of developing the more severe form of the disease, namely PE, with independent predictors of VTE in the postdischarge period including previous VTE and cancer.

Effectiveness of Standardized Venous Thromboembolism Prophylaxis Order Sets in Patients Undergoing Abdominal or Pelvic Surgery for Cancer

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4248-4248
Author(s):  
Molly Weidner Mandernach ◽  
Richard Lottenberg ◽  
Thomas Johns ◽  
Elaine Speed ◽  
Russell L Findlay ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Stratification ◽  
Pelvic Surgery ◽  
Vte Prophylaxis ◽  
Order Sets ◽  
Pharmacologic Prophylaxis ◽  
The Mean ◽  
Length Of Hospitalization ◽  
Order Set

Abstract Abstract 4248 Background: In our tertiary academic medical center, standardized pre-printed physician order sets were implemented in 2008 for inpatient venous thromboembolism (VTE) risk stratification and prophylaxis on the day of admission. Electronic medical records were not utilized during the study period. Recommendations for pharmacologic prophylaxis were derived from the 2008 American College of Chest Physicians (ACCP) guidelines. Patients undergoing abdominal or pelvic surgery for cancer were specifically identified in the highest risk category with enoxaparin, fondaparinux, or warfarin (goal INR 2–3) provided as options for pharmacologic VTE prophylaxis. Sequential compression devices (SCDs) were also recommended. This retrospective analysis evaluates adherence to risk stratification and recommendations for pharmacologic VTE prophylaxis in patients undergoing abdominal or pelvic surgery for cancer. Methods: Using the hospital administrative database, all patients ≥ 18 years hospitalized between January 1, 2009 and December 31, 2010 were identified by ICD-9 codes for cancer and surgery performed. Patients undergoing an abdominal or pelvic surgery for cancer lasting >45 minutes were included. Exclusion criteria were age >90 years, patients requiring therapeutic anticoagulation, length of hospitalization <24 hours or >30 days, transplant recipients, patients requiring multiple visits to the operating room during hospitalization, laparoscopic or transurethral procedures, and esophagectomy. Primary outcomes included adherence to order set risk stratification and pharmacologic VTE prophylaxis recommendations, and timing, type, and dose of pharmacologic VTE prophylaxis prescribed. Chart review of physician orders for mechanical and pharmacologic prophylaxis for each day of hospitalization was completed on all patients. Operative reports, medication administration records, and progress notes were reviewed if clarification of physician orders was required. Administration of the prescribed medication during hospitalization was not verified. Results: A total of 773 hospital admissions representing 767 patients met inclusion criteria. The mean length of hospitalization was 7 +/− 5 days during the study period. The mean age was 62 +/− 12 years and 51% were female. Pharmacologic prophylaxis was prescribed 5645 of 6147 patient days (91.8%). Enoxaparin was prescribed 630 (9.8%) patient days, and fondaparinux in 15 patient days (0.002%). Although not indicated as an option for this patient population in our order set, low dose unfractionated heparin (LDUH) was prescribed 4991 (81.2%) of the patient days and was to be dosed every 8 hours (80%) or every 12 hours (19.8%). Warfarin was not prescribed. Mechanical thromboprophylaxis with SCDs was ordered 93.7% of the patient encounters on the day of surgery. The standardized pre-printed physician order set was utilized for prescribing prophylaxis at the time of admission for 630 (82.1%) patient encounters. Clinicians risk stratified only 350 (45.3%) of these patient encounters per the order set guidelines. Of those, 131 (37.4%) were appropriately deemed high risk based upon “abdominal/pelvic cancer undergoing operative procedure”. In the high risk group, LDUH was prescribed in 90 (68.7%) patient encounters, and enoxaparin as recommended in 30 (22.9%). Eleven (8.4%) were not prescribed pharmacologic prophylaxis on the day of admission. Conclusion: Completion of standardized pre-printed physician order sets with appropriate risk stratification in patients undergoing major, open abdominal or pelvic surgery for cancer is underutilized in our institution. Although pharmacologic prophylaxis is prescribed for the majority of inpatient days, LDUH is primarily ordered despite preferred recommendations in favor of enoxaparin or fondaparinux. Thus, an opportunity exists to implement an educational intervention to improve adherence to evidence based order set risk stratification and pharmacologic VTE prophylaxis recommendations. Disclosures: No relevant conflicts of interest to declare.

Lack of extended venous thromboembolism prophylaxis in high-risk patients undergoing major orthopaedic or major cancer surgery

2009 ◽  
Vol 102 (07) ◽  
pp. 56-61 ◽  
Author(s):  
Klaus-Arno Siebenrock ◽  
Urs Metzger ◽  
Philipp Tuor ◽  
Daniel Sterzing ◽  
Kurt Oehy ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
High Risk ◽  
Knee Replacement ◽  
Hip Replacement ◽  
Orthopaedic Surgery ◽  
Cancer Surgery ◽  
Interquartile Range ◽  
Major Surgery ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis

SummaryExtended pharmacological venous thromboembolism (VTE) prophylaxis beyond discharge is recommended for patients undergoing high-risk surgery. We prospectively investigated prophylaxis in 1,046 consecutive patients undergoing major orthopaedic (70%) or major cancer surgery (30%) in 14 Swiss hospitals. Appropriate in-hospital prophylaxis was used in 1,003 (96%) patients. At discharge, 638 (61%) patients received prescription for extended pharmacological prophylaxis: 564 (77%) after orthopaedic surgery, and 74 (23%) after cancer surgery (p <0.001). Patients with knee replacement (94%), hip replacement (81%), major trauma (80%), and curative arthroscopy (73%) had the highest prescription rates for extended VTE prophylaxis; the lowest rates were found in patients undergoing major surgery for thoracic (7%),gastrointestinal (19%),and hepatobiliary (33%) cancer. The median duration of prescribed extended prophylax is was longer in patients with orthopaedic surgery (32 days, interquartile range 14–40 days) than in patients with cancer surgery (23 days, interquartile range 11–30 days; p<0.001).Among the 278 patients with an extended prophylaxis order after hip replacement, knee replacement, or hip fracture surgery, 120 (43%) received a prescription for at least 35 days, and among the 74 patients with an extended prophylaxis order after major cancer surgery, 20 (27%) received a prescription for at least 28 days. In conclusion, approximately one quarter of the patients with major orthopaedic surgery and more than three quarters of the patients with major cancer surgery did not receive prescription for extended VTE prophylaxis. Future effort should focus on the improvement of extended VTE prophylaxis, particularly in patients undergoing major cancer surgery.

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