Compliance with Anti-thrombotic Guidelines
Despite the guidelines, many patients do not receive effective prophylaxis; one study found that fewer than one in five elderly patients received post-discharge thromboprophylaxis after THA or TKA. Analysis of the Global Orthopaedic Registry (GLORY) found that whereas almost all THA patients received a form of prophylaxis, only 47% of patients received prophylaxis in compliance with ACCP guidelines in terms of type, duration, start time and dose. There are a number of possible reasons for this lack of adherence, including concerns about the risks of prophylaxis.[24–26] However, there is little evidence that prophylaxis causes surgical bleeding or that bleeding after arthroplasty compromises the short- or long-term outcomes. In fact, the rate of major bleeding after major knee surgery was found to be similar in patients who received LMWH or placebo (2.5 vs 2.4%). Another potential barrier to the optimal use of thromboprophylaxis could be the inconvenience of sc. administration or coagulation monitoring and overall costs associated with currently available agents,[30,31] particularly in light of recommendations for extended post-discharge thromboprophylaxis. The ideal regimen for an anticoagulant for optimal convenience would be once-daily (q.d.) oral provision, which may also facilitate compliance.
Expert Rev Pharmacoeconomics Outcomes Res. 2011;11(3):299-306. © 2011 Expert Reviews Ltd.
Cite this: Economic Impact of Venous Thromboembolism After Hip and Knee Arthroplasty - Medscape - Jun 01, 2011.