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

Autori
Kolundžić, Robert ; Šimić Jovičić, Marijana ; Ðinkić, Maja ; Petrović, Tadija ; Crnković, Tomislav ; Trkulja, Vladimir

Izvornik
Medicinski glasnik Ljekarske komore Zeničko- dobojskog kantona (1840-0132) 14 (2017), 2; 244-249

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, članak, znanstveni

Ključne riječi
hip ; knee ; arthroplasty ; venous thromboembolism

Sažetak
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.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA