Warfarin should not be used for thromboprohylaxis in elective major orthopaedic surgery: a Croatian perspective

Scientific paper - Original scientific paper

• Author: Robert Kolundžić
• Author: Marijana Šimić Jovičić
• Author: Maja Đinkić
• Author: Tadija Petrović
• Author: Tomislav Crnković
• Author: Vladimir Trkulja
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

Aim: To identify modes of venous thromboembolism (VTE) prophylaxis in patients undergoing elective major orthopaedic surgery (total hip or knee arthroplasty, THA/TKA) at a single university-associated hospital in Croatia. ----- Methods: A retrospective analysis of consecutive patients subjected to THA or TKA over a two-year period (2014-2015) with a focus on anticoagulation during the first 15 post-surgical days (period of highest VTE risk). ----- Results: Of 603 identified patients three (0.5%) were not anticoagulated (haemophilia) and others received perioperative doses of low molecular weight heparins (LMWH). Overall, 228 (37.8%) patients received prophylaxis not involving warfarin, and 372 continued with short-term LMWH with switching to warfarin. They contributed a total of 1218 international normalized ratio (INR) values (median=3, range=1-8). These were consistently below the target INR range across the observed period. Between post-surgical days 6 and 15 (after the initial titration), 438 values were taken in patients treated with LMWH+warfarin and 92.7% were below, and only 6.8% within the target range; 580 values were taken in patients already switched to warfarin, 74% were below and only 25% within the range. ----- Conclusion: The prevailing mode of VTE prophylaxis was in a clear contrast to (then) actual professional guidelines, with inadequate monitoring and poor anticoagulation. There is no reason to expect a substantially different situation at other institutions across the country. The prevailing practice of VTE prophylaxis in major orthopaedic surgery in Croatia should be promptly abandoned and up-dated in agreement with the current state of the art.

Abstract (croatian)

Cilj: Identificirati modalitete prevencije venskog tromboembolizma (VTE) u bolesnika podvrgnutih elektivnim velikim ortopedskim zahvatima (totalna artroplastika kuka ili koljena) u jednom sveučilišnom medicinskom centru u Hrvatskoj. ----- Metode: Retrospektivna analiza podataka o uzastopnim bolesnicima, podvrgnutim totalnoj artroplastici kuka ili koljena, tijekom dvije godine (2014-2015), s fokusom na antikoagulacijsko liječenje tijekom
prvih 15 postoperativnih dana (razdoblje najvišeg rizika za VTE). ----- Rezultati: Od ukupno 603 bolesnika, troje (0.5%) nisu bili antikoagulirani (hemofilija), dok su ostali primili preoperativne doze niskomolekularnog heparina (LMWH). U ukupno 228 (37.8%) bolesnika antikoagulacijski tretman nije uključivao varfarin, dok su 372 bolesnika tretirana kratkotrajnom primjenom LMWH-a s prijelazom na varfarin. Tijekom promatranog razdoblja ukupno je izmjereno 1.218 vrijednosti internacionalnog normaliziranog omjera (INR) (medijan=3, raspon= 1-8, po bolesniku). Vrijednosti su konzistentno bile ispod terapijskog INR-raspona. U razdoblju između šestog i petnaestog postoperativnog dana (nakon početne titracije), ukupno je izmjereno 438 INR-vrijednosti u bolesnika
koji su primali i LMWH i varfarin, te je 92.7% njih bilo ispod terapijskog raspona, a samo 6.8% vrijednosti bilo je u terapijskom rasponu. Istodobno, izmjereno je ukupno 580 INR-vrijednosti u bolesnika koji su već bili prebačeni na varfarin – 74% vrijednosti bilo je ispod, a samo 25% vrijednosti bilo je u terapijskom rasponu. ----- Zaključak: Opaženi dominantni oblik VTE profilakse u izravnoj je suprotnosti s profesionalnim smjernicama, s neadekvatnim nadzorom i nedostatnom antikoagulacijom. Nema razloga očekivati da je stanje bitno drugačije u ostalim institucijama u zemlji. Taj predominantni oblik VTE profilakse u velikim ortopedskim zahvatima u Hrvatskoj treba što prije napustiti i uvesti postupke u skladu s trenutno važećim standardima dobre kliničke prakse.

• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Medicinski glasnik
• Numbering: vol. 14, no. 2, pp. 244-249
• p-ISSN: 1840-0132
• DOI: https://doi.org/10.17392/902-17
• URN:NBN: urn:nbn:hr:105:185257
• Publication: 2017-08-01
• Document URL: https://doi.org/10.17392/902-17
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 09:16:48