Abstract

Abstract 2097

Poster Board II-74

Background:

Patients who undergo major orthopedic surgery are at significant risk of developing VTE. As 40-60% of orthopedic surgery patients develop VTE in the absence of thromboprophylaxis, evidence-based guidelines recommend pharmacological VTE prophylaxis in all patients without contraindications. As the risk of VTE persists beyond discharge in these patients, the use of LMWH and warfarin post-discharge is both suitable and recommended. However, a lack of awareness and education often leads to an absence of VTE prophylaxis post-discharge. This analysis evaluated in-hospital and post-discharge VTE prophylaxis patterns for US orthopedic surgery patients.

Methods:

Premier's Perspective” inpatient data were cross-matched at the individual patient level with Ingenix LabRx® outpatient data from the I3 database (January 2005-December 2007) to assess VTE prophylaxis patterns in major orthopedic surgery (total knee arthroplasty, total hip arthroplasty, hip fracture surgery) patients at risk of VTE (according to the American College of Chest Physicians 2004 guidelines) and with no contraindications for anticoagulation. Inpatients were assessed for the anticoagulant received in-hospital and were followed post-discharge to assess their outpatient prophylaxis use. Drug utilization and clinical practice patterns during and within 30 days after hospitalization were collected and compared descriptively between groups.

Results:

Of the 3,311 orthopedic surgery discharges at risk of VTE and included in this analysis, only 295 (8.9%) did not receive any anticoagulation at all. Of the remaining 3,016 (91.1%) discharges that did receive anticoagulation, 1,061 (35.2%) received enoxaparin, 1,028 (34.1%) received warfarin, and the remaining 927 (30.7%) received other or combination prophylaxis. However, after discharge only 1,800 (54.4%) of all patients received prophylaxis, with the majority receiving warfarin (1,028, 57.1%). The remaining 1,511 (45.6%) received no outpatient prophylaxis (Table).

Table

In-hospital and post-discharge VTE prophylaxis patterns

Prophylaxis patterns Discharges (%) N=3,311 
Anticoagulants during hospitalization 
None 295 (8.9) 
Any 3,016 (91.1) 
    Warfarin only 1,028 (34.1) 
    Enoxaparin only 1,061 (35.2) 
    Other (fondaparinux, dalteparin, UFH, combination) 927 (30.7) 
Anticoagulants within 30 days of discharge 
None 1,511 (45.6) 
    Any 1,800 (54.4) 
    ;Warfarin only 1,028 (57.1) 
    Enoxaparin only 612 (34.0) 
    Other (enoxaparin, fondaparinux, dalteparin ± warfarin or other combination) 160 (8.9) 
Prophylaxis patterns Discharges (%) N=3,311 
Anticoagulants during hospitalization 
None 295 (8.9) 
Any 3,016 (91.1) 
    Warfarin only 1,028 (34.1) 
    Enoxaparin only 1,061 (35.2) 
    Other (fondaparinux, dalteparin, UFH, combination) 927 (30.7) 
Anticoagulants within 30 days of discharge 
None 1,511 (45.6) 
    Any 1,800 (54.4) 
    ;Warfarin only 1,028 (57.1) 
    Enoxaparin only 612 (34.0) 
    Other (enoxaparin, fondaparinux, dalteparin ± warfarin or other combination) 160 (8.9) 
Conclusion:

This analysis presents both inpatient and outpatient VTE prophylaxis patterns in real-world orthopedic surgery patients that are at risk of VTE. Although the rate of prophylaxis was high in inpatients, approximately half of all patients had no prophylaxis post-discharge. Further efforts to improve VTE prevention in discharged orthopedic surgery patients are required.

Disclosures:

Amin:sanofi-aventis: Research Funding, Speakers Bureau, The authors received editorial/writing support in the preparation of this abstract funded by sanofi-aventis U.S., Inc. . Lin:sanofi-aventis: Employment. Ryan:sanofi-aventis: Research Funding.

Author notes

*

Asterisk with author names denotes non-ASH members.