Program for the prevention of venous thromboembolism in high-risk orthopaedic patients

J Arthroplasty. 1991:6 Suppl:S11-6. doi: 10.1016/s0883-5403(08)80050-2.

Abstract

Postoperative orthopaedic patients remain at risk for venous thromboembolism (VTE) after hospital discharge. Therefore, the authors designed and implemented a program for prevention of VTE that included outpatient adjusted-dose warfarin using twice-weekly prothrombin time (PT) determinations, a dedicated telephone line for PT results, and vigilant nurse-physician supervision to administer prophylaxis to 125 postoperative orthopaedic patients against VTE for an average of 31.4 days after discharge. PT was maintained between 13.2 and 18.3 seconds (1.1-1.5 x control) in the average patient. There was a failure rate of 3.2% and 0.8% for clinically suspected and radiologically confirmed deep venous thrombosis (DVT) and pulmonary embolism (PE), respectively. The rate of bleeding complications was 3.2%, but none of these patients required transfusion or hospital readmission for hemorrhage. The authors conclude that the described program for VTE prevention is a safe, effective, and practical program to administer prophylaxis to postoperative orthopaedic patients against clinically evident VTE for the first month after hospital discharge.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Orthopedics*
  • Patient Discharge
  • Postoperative Complications / prevention & control*
  • Prothrombin Time
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / prevention & control
  • Radiography
  • Risk Factors
  • Thromboembolism / diagnostic imaging
  • Thromboembolism / prevention & control*
  • Thrombophlebitis / diagnostic imaging
  • Thrombophlebitis / prevention & control
  • Warfarin / administration & dosage

Substances

  • Warfarin