Evaluation and improvement of venous thromboembolism prophylaxis pattern in patients admitted to orthopedic ward in a tertiary teaching hospital: Improvement of VTE prophylaxis

Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE incidence in major orthopedic surgery ranges from 40% to 60%. Several risk factors are responsible for VTE incidences, such as age, obesity and immobility. This study was designed and performed to evaluate the process of thromboprophylaxis in patients undergoing orthopedic surgery with and without pharmacist intervention to improve prescribing. A total of 306 patients were randomly enrolled in the two phases of this study. To investigate the cause of VTE, 201 patients receiving no pharmacist interference as study phase one and 105 patients receiving pharmacist interference as study phase two were evaluated. Rate of occurrence of risk was calculated using the Caprine scoring system. The trend of prescription and the reasons for not prescribing the drugs under consideration for the patients, were investigated. As a subsidiary aim to the study and to increase economical productivity, the prescription of heparin instead of other anticoagulating drugs was suggested in pharmacotherapy consultation. In the first phase of the research, it was proven that 161 (80.1%) of the patients under consideration needed the prophylaxis but 40 (19.9%) of them did not. After the investigation, 171 (85.1%) of the patients according to the guideline and 30 (14.9%) without considering the guideline underwent prophylaxis. In the second phase of the research, 40 (38.1%) of the patients did not require prophylaxis treatment but 65 (61.9%) did. After investigation and drug interaction results, 96 (91.43%) according to the guideline and 9 without considering the guideline were treated with the prophylaxis drug. Despite the active presence and cooperation of pharmacists, 4.76% who did not need prophylaxis received it, and 6.15% who needed prophylaxis did not receive it despite the pharmacist's intervention. Moreover, 2.86% of patients who were prohibited from taking enoxaparin were allowed to take heparin after pharmacist intervention. This research showed that active cooperation between orthopedist and pharmacist in prescribing the required drug(s) is very low. For this reason, the continuous presence of a pharmaceutical group as well as changes in protocols can serve as an effective, logical step in the prescription of drugs.