Key result
Pharmacologic VTE prophylaxis was near universal among older adults undergoing hip or knee replacement, with DOACs increasingly used and overall adverse event rates remaining below 1%.
Why the study?
Trends in VTE prophylaxis prescriptions after hip and knee replacement since DOAC approval and the 2012 guideline endorsement of aspirin, as well as risks of adverse events, were unknown.
Observational (n=10,503)
Yes
Following DOAC approval and 2012 guidelines, VTE prophylaxis after joint replacement in older adults is near universal, with increasing DOAC and aspirin use and very low adverse event rates.
Supports high VTE prophylaxis adherence with low events in older adults post-joint replacement; leaves open comparative DOAC effectiveness.
Trends in prescription for venous thromboembolism (VTE) prophylaxis following total hip (THR) and knee replacement (TKR) since the approval of direct oral anticoagulants (DOACs) and the 2012 guideline endorsement of aspirin are unknown, as are the risks of adverse events. We examined practice patterns in the prescription of prophylaxis agents and the risk of adverse events during the in-hospital period (the 'in-hospital sample') and 90 days following discharge (the 'discharge sample') among adults aged ⩾ 65 undergoing THR and TKR in community hospitals in the Institute for Health Metrics database over a 30-month period during 2011 to 2013. Eligible medications included fondaparinux, DOACs, low molecular weight heparin (LMWH), other heparin products, warfarin, and aspirin. Outcomes were validated by physician review of source documents: VTE, major hemorrhage, cardiovascular events, and death. The in-hospital and the discharge samples included 10,503 and 5722 adults from 65 hospitals nationwide, respectively (mean age 73, 74 years; 61%, 63% women). Pharmacologic prophylaxis was near universal during the in-hospital period (93%) and at discharge (99%). DOAC use increased substantially and was the prophylaxis of choice for nearly a quarter (in-hospital) and a third (discharge) of the patients. Aspirin was the sole discharge prophylactic agent for 17% and 19% of patients undergoing THR and TKR, respectively. Warfarin remained the prophylaxis agent of choice for patients aged 80 years and older. The overall risk of adverse events was low, at less than 1% for both the in-hospital and discharge outcomes. The low number of adverse events precluded statistical comparison of prophylaxis regimens.
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Ko et al. (2020) conducted an observational in Total hip and knee replacement (n=10,503). Pharmacologic VTE prophylaxis (DOACs, aspirin, warfarin, LMWH, etc.) was evaluated on Adverse events (VTE, major hemorrhage, cardiovascular events, and death). Pharmacologic VTE prophylaxis was near universal among older adults undergoing hip or knee replacement, with DOACs increasingly used and overall adverse event rates remaining below 1%.
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