Prevention of Venous Thromboembolism in Orthopaedics in the United States

The use of different types of antithrombotic prophylactics in various clinical settings was examined. A standardized questionnaire was mailed to 5000 randomly selected practicing orthopaedic surgeons that detailed practice profile, surgical case type and frequency, method of thromboembolism prophylaxis used, incidence of morbidity, and type of screening used. Twenty-one percent (n = 1046) of surgeons surveyed returned the questionnaire. Four of 5 surgeons performing elective hip arthroplasty used some form of thromboembolic prophylaxis for all of their patients, 13% used prophylaxis only for patients considered to be at high risk, and 3% of respondents never used prophylaxis. The rates of prophylactic use for patients undergoing elective knee arthroplasty were similar. A considerably lower rate of routine prophylactic use was seen among surgeons performing surgery for pelvic and lower extremity trauma. Except for cases involving neurologic compromise, most patients undergoing either elective or traumatic spinal surgery were not given prophylaxis. Low dose warfarin alone was the most commonly used prophylaxis modality. A comparison of the results of the current survey with those of past surveys showed that the use of aspirin has fallen. The use of routine pharmacologic prophylaxis against thromboembolism in hip and knee arthroplasty has become the standard of care in the United States. Among patients undergoing surgery for hip fracture and other lower extremity trauma, however, prophylaxis remains underused.