10Sep 2017

EVALUATION OF VENOUS THROMBO-EMBOLISM PROPHYLAXIS IN PATIENTS UNDERGOING MAJOR ORTHOPEDIC SURGERIES (HIP & KNEE) IN EGYPT.

  • El Salam Hospital, Cairo, Egypt.
  • Ain Shams Specialized Hospital, Cairo, Egypt.
  • Nozha International Hospital, Cairo, Egypt.
  • El Hadra University Hospital, Alexandria, Egypt.
  • Abo Keer Specialized Hospital, Alexandria, Egypt.
  • Royal Hopsital, Alexandria, Egypt.
  • El Horea Hospital, Cairo, Egypt.
  • El Madeena El Tebya Hospital, Alexandria, Egypt.
  • Ibrahim Ebeid Hospital, Alexandria, Egypt.
  • El Hawamdeya Medical Centre, Giza, Egypt.
  • Giza International Hospital, Giza, Egypt.
  • Al Hadra University Hospital, Alexndria, Egypt.
  • El Masoura Educational Hospital, Mansoura, Egypt.
  • Mahmoud Hospital, Giza, Egypt.
  • Al Ahrar Hospital, Sharqia, Egypt.
  • Egypt Air Hospital, Cairo, Egypt.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Venous thrombo-embolism (VTE) is a major health threat despite the availability of various prophylactic regimens with favourable benefit-risk ratio. Guidelines on thrombo-embolic disorders and their management are also available. However, there are still gaps between guidelines and real life clinical practice. Patients undergoing major orthopedic surgeries are at high risk of developing VTE. Our study aims to compare real life VTE prophylaxis received by patients to the recommendations set by international ACCP guidelines (2008) during hospitalization and after hospital discharge and to detect the possible reasons for discrepancies. The study was a local, multicenter, longitudinal, non-interventional study with 4-6 weeks follow-up for patients undergoing major orthopedic surgeries and included a total of 3 visits; admission visit, discharge visit, and a follow-up visit. Each of the twenty active wards recruited around 10 to 15 consecutive patients. When this study was conducted, data was compared to what was recommended by ACCP 2008 guidelines to assess compliance. Our results shows that real life VTE prophylaxis was compliant to ACCP 2008 guidelines in a majority of patients both during hospitalization (96.6%; 95% CI: 94.7, 98.6%) and after hospital discharge (73.3%; 95% CI: 68.4, 78.2%). Reasons for non-compliance to guidelines during hospitalization included late starting of VTE prophylaxis, not prescribing VTE prophylaxis and prescribing other anti-thrombotic agents not recommended by the guidelines. Reasons for post discharge non-compliance included no prophylaxis, longer or shorter prophylaxis and prescribing other anti-thrombotic agents not recommended by the guidelines. VTE prophylactic medications prescribed for patients who underwent major orthopedic surgery were compliant to ACCP 2008 guidelines during hospitalization and after hospital discharge.


  1. Lindblad B, Sterny NH, Bergqvist D. (1991) Incidence of venous thromboembolism verified by necroscopy over 30 years. BMJ 302:709-11.
  2. Lindblad B, Eriksson A, Bergqvist D. (1988) Autopsy-verified pulmonary embolism in a surgical department: analysis of the period from 1951 to 1988. Br J Surg 78:849-52.
  3. Nordstrom M, Lindblad B, Bergvist D, Kjellstrom T. (1992) Prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med 232:155-60.
  4. Heit JA. (2006) Epidemiology of venous thromboembolism in the community: implication for prevention and management. J Thromb Thrombolysis 21:23-9.
  5. Anderson FA Jr, Wheeler HB, Golberg RJ, Hosmer DW, Forcier A. (1992) The prevalence of risk factors for venous thromboembolism among hospital patients. Arch Intern Med. 152:1660-4.
  6. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O?Fallon WM, Melton LJ. (1999) Predictors of survival after deep vein thrombosis and pulmonary embolism: a population-based, cohort study. Arch Intern Med 159:445-53.
  7. Heit JA, Silverstein MD, Mohr DN, Petterson TM, O?Fallon WM, Melton LJ. (2000) Risk factors for deep vein thrombosis and pulmonary embolism: a population-based, case-controlled study. Arch Intern Med 160:809-15.
  8. Goubran HA, Sholkamy S, El-Haddad A, Mahmoud A, Rizkallah MA, Sobhy G. (2012) Venous thromboembolism risk and prophylaxis in the acute hospital care setting: report from the ENDORSE study in Egypt. Thrombosis Journal 10:20. DOI 10.1186/1477-9560-10-20.
  9. Geerts WH, Bergqvist D, Pineo GF et al. (2008) Prevention of venous thromboembolism: Antithrombotic and Thrombolytic Therapy. 8th Ed: ACCP guidelines. Chest 133:381S-453S.
  10. Ajay K. Kakkar and Sophie K. Rushton-Smith. (2013) Incidence of Venous Thromboembolism in Orthopedic Surgery. Thromboembolism in Orthopedic Surgery, 11DOI 10.1007/978-1-4471-4336-9_2, Chapter: 2, Publisher: Springer, Editors: Juan V Llau, pp.11-17
  11. Angelli G, Mancini GB, Biagini D. (2000) The rationale for long-term prophylaxis of venous thromboembolism. Orthopedics. 23(6 Suppl):s643-6.
  12. ARCELUS J, KUDRNA J, CAPRINI J. (2006) Venous Thromboembolism Following Major Orthopedic Surgery: What is the Risk After Discharge? Orthopedics 29(6). DOI: 10.3928/01477447-20060601-16
  13. RANDEL A. (2012) ACP Recommendations for VTE Prophylaxis in Hospitalized Patients. American Family Physician 85(12):1204.
  14. European Medicines Agency (2006) Committee for medicinal products for human use Guideline on clinical investigation of medicinal products for prophylaxis of high intra- and post- operative venous thromboembolic risk. CPMP/EWP/707/98 Rev. 1. ema.europe.eu/docs/en_GB/document_library/scientific_guideline/2009/09/WC500003301.pdf
  15. Forsh D. (2015) Deep Venous Thrombosis Prophylaxis in Orthopedic Surgery. Medscape.
  16. EMEA guideline on clinical investigation of medicinal products for prophylaxis of high intra and post-operative venous thromboembolic risk, 17 November 2007.
  17. Prevention of Venous Thromboembolism: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Michael R. Lassen, Clifford W. Colwell and Joel G. Ray. William H. Geerts, Graham F. Pineo, John A. Heit, David Bergqvist, Chest 2004;126;338S-400S.
  18. National Clinical Guideline Centre ? Acute and Chronic Conditions (UK). Venous Thromboembolism (Deep Venous Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital. London: Royal college of Physicians (UK); 2010. (NICE Clinical Guidelines, No. 92.) 6, Summary of the effectiveness of mechanical and pharmacological prophylaxis. Available from: http://www.ncbi.nlm.nih.gov/books/NBK116512/
  19. Ageno W, Squizzato A, Ambrosini F (2002) Thrombosis prophylaxis in medical patients: a retrospective review of clinical practice patterns. Acta Haematologica. 87:746?750
  20. Arnold DM, Kahn SR, Shrier I. (2001) Missed opportunities for prevention of venous thromboembolism: an evaluation of the use of thromboprophylaxis guidelines. Chest. 120:1964?1971
  21. Anderson FA Jr, Audet A-M, St John R. (1998) Practices in the prevention of venous thromboembolism. J Thromb Thrombol. 5:S7?S11
  22. Ahmad HA, Geissler A, MacLellan DG. (2002) Deep venous thrombosis prophylaxis: are guidelines being followed? ANZ J Surg. 72:331?334
  23. Tapson VF, Decousus H, Piovella F, Zotz RB, Allegrone J, Anderson FA Jr. (2003) A multinational observational cohort study in acutely ill medical patients of practices in prevention of venous thromboembolism: findings of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE). Blood. 102(11):321a.
  24. Tapson VF, Goldhaber SZ. (2003) Failure to prophylax for deep vein thrombosis: results from the DVT FREE registry. Blood 102 (Abstract 1156).
  25. Stinnett JM, Pendleton R, Skordos L, Wheeler M, Rodgers GM. (2005) Venous thromboembolism prophylaxis in medically ill patients and the development of strategies to improve prophylaxis rates. Am J Hematol. 78(3):167?172.
  26. Lentine KL, Flavin KE, Gould MK. (2005) Variability in the use of thromboprophylaxis and outcomes in critically ill medical patients. Am J Med. 118(12):1373?1380.
  27. Ellrodt AG, Conner L, Riedlinger M, Weingarten S. (1995) Measuring and improving physician compliance with clinical practice guidelines. A controlled interventional trial. Ann Intern Med. 122(4):277?282.
  28. Caprini JA, Hyers TM. (2006) Compliance with antithrombotic guidelines. Manag Care. 15(9):49?50, 53-60, 66.

[Ahmed Hassan, Timour El Husseiny, Mahmoud El Sebaie, Ayman Soliman, Yousry Emad, Mohamed El Shafie, Ehab Shehata, Essam Al Abassi, Osama Mostafa, Abdallah Kaddah, Ahmed Morrah, Adel Wanas, Adham El Sharkawi, Osama El Shazli, Ahmed Galal, Mohamed Zaki, Sami Nafie, Magdy El Sayed and El Zaher Hasan. (2017); EVALUATION OF VENOUS THROMBO-EMBOLISM PROPHYLAXIS IN PATIENTS UNDERGOING MAJOR ORTHOPEDIC SURGERIES (HIP & KNEE) IN EGYPT. Int. J. of Adv. Res. 5 (9). 104-113] (ISSN 2320-5407). www.journalijar.com


Dr. Ahmad Hassan
Professor of orthopedicsurgery , Alexandria University Hospital

DOI:


Article DOI: 10.21474/IJAR01/5307       DOI URL: http://dx.doi.org/10.21474/IJAR01/5307


Share this article