Key result
Omitting thromboprophylaxis in orthopedic surgery leads to thromboembolism in ~60% of patients, necessitating uniform guidelines.
Why the study?
Orthopedic surgeries carry a high risk of thromboembolism, but anticoagulant therapy faces challenges including bleeding risk, monitoring demands, lack of guideline consensus, and deficient risk stratification.
Personalized risk assessment models and uniform guidelines are needed to improve thromboprophylaxis outcomes and manage bleeding risks in orthopedic surgery.
Answers are grounded in this paper and cite their sources.
Emphasizes VTE risk without prophylaxis in orthopedics; supports personalized models but leaves optimal guidelines open pending prospective data.
Orthopedic surgeries are associated with high-risk of thromboembolism which occurs in 40% to 60% of orthopedic patients in the absence of thromboprophylaxis. Conventionally heparin anticoagulants were used for thromboprophylaxis and currently direct oral anticoagulants (DOACs) are widely used due to their minimal complexity. Anticoagulant use carries bleeding risk and requires optimal laboratory monitoring through conventional thrombin-based assays, anti-Xa assay, anti-IIa assay and contemporary ecarin chromogenic assay (ECA) and rotational thromboelastometry. Monitoring requires multiple hospital visits and hence, the development of point-of-care assays is gaining momentum. Also, a thorough risk assessment model (RAM) is necessary for successful anticoagulant therapy since it enables personalized approach for better thromboprophylaxis outcomes. Despite welcoming changes, lack of guideline consensus, population-based thromboprophylaxis, deficiencies in risk stratification and non-adherence are still a concern. Stronger clinical and process support system with uniform guidelines approaches and patient-specific RAM can aid in the successful implementation of anticoagulant therapy.
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Wang et al. (2024) conducted a review in Orthopedic surgery requiring thromboprophylaxis. Anticoagulant therapy was evaluated. The absence of thromboprophylaxis in orthopedic surgeries leads to thromboembolism in 40% to 60% of patients, necessitating patient-specific risk assessment models and uniform guidelines.
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