gms | German Medical Science

20th Annual Meeting of the German Drug Utilisation Research Group (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

05.12. - 06.12.2013, Düsseldorf

Duration of pharmacological thromboembolic prophylaxis after major joint arthroplasty – deviations between guidelines and real-life

Meeting Abstract

  • corresponding author presenting/speaker Susanne Nehls - Institute for Clinical Pharmacology, University Medicine Rostock, Rostock, Germany
  • author Günther Kundt - Institute for Biostatistics and Informatics in Medicine and Aging Research, University Medicine Rostock, Rostock, Germany
  • author Änne Glass - Institute for Biostatistics and Informatics in Medicine and Aging Research, University Medicine Rostock, Rostock, Germany
  • author Frank Thiessen - Institute for Biostatistics and Informatics in Medicine and Aging Research, University Medicine Rostock, Rostock, Germany
  • author Wolfram Mittelmeier - Clinic for Orthopaedics, University Medicine Rostock, Rostock, Germany
  • author Dirk Flachsmeyer - Department of Trauma and Orthopaedic Surgery, Klinikum Suedstadt Rostock, Rostock, Germany
  • author Bernd Drewelow - Institute for Clinical Pharmacology, University Medicine Rostock, Rostock, Germany
  • author Silke Müller - Institute for Clinical Pharmacology, University Medicine Rostock, Rostock, Germany

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 20. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Düsseldorf, 05.-06.12.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. Doc13gaa10

doi: 10.3205/13gaa10, urn:nbn:de:0183-13gaa108

Published: November 25, 2013

© 2013 Nehls et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Background: Whilst most guidelines routinely recommend medical prophylaxis of venous thromboembolism (VTE) for patients after total hip (THR) and total knee replacement (TKR) they are divided over the thromboprophylactic regimes. Additionally the SPCs of low molecular weight heparins (LMWH) and oral anticoagulants (OAK) recommend different durations of prophylaxis. The aim of this analysis was to compare duration of VTE prophylaxis in routine care to the guidelines of the Association of the Scientific Medical Societies in Germany (AWMF) [1] and to the SPCs of the used anticoagulants. Unjustified deviations were focused.

Materials and Methods: All patients undergoing elective THR or TKR at two major hospitals between July 2009 and December 2011 were eligible to participate in the prospective observational cohort-study. After written consent patients were followed for three months using patient interviews and chart review.

Results: 613 patients were included (59.5% female) into the study: 127 (20.7%) received rivaroxaban, 209 (34.1%) dabigatran and 277 (45.2%) patients received a LMWH. Only in 2.9% of TKR patients a duration according to AWMF guidelines was observed; in THR patients 67.3% were adequate. Regarding OAK cohorts a wide variance appeared between accordance to SPCs. In case of dabigatran 65.5% of THR patients and 2.8% of TKR patients received correct prophylaxis, whereas under rivaroxaban in only 4.2% cases an appropriate duration was observed.

Conclusion: Especially in patients after total knee arthroplasty duration of medical VTE prophylaxis in real-life differs markedly from recommendations in German guidelines (AWMF) and SPCs of used anticoagulants. A closer consideration of the reasons for these deviations could be helpful to improve the information given to practitioners.

The study was supported by BfArM V-11343/68605


References

1.
Association of the Scientific Medical Societies in Germany (AWMF). S3-Leitlinie Prophylaxe der venoesen Thromboembolie (VTE). Available from: http://www.awmf.org/uploads/tx_szleitlinien/003-001l_S3_Thromboembolie-Prophylaxe_2010.pdf. Accessed September 15, 2013. External link