Program for the prevention of venous thromboembolism in high-risk orthopaedic patients.
Postoperative orthopaedic patients remain at risk for venous thromboembolism (VTE) after hospital discharge. Therefore, the authors designed and implemented a program for prevention of VTE that included outpatient adjusted-dose warfarin using twice-weekly prothrombin time (PT) determinations, a dedicated telephone line for PT results, and vigilant nurse-physician supervision to administer prophylaxis to 125 postoperative orthopaedic patients against VTE for an average of 31.4 days after discharge. PT was maintained between 13.2 and 18.3 seconds (1.1-1.5 x control) in the average patient. There was a failure rate of 3.2% and 0.8% for clinically suspected and radiologically confirmed deep venous thrombosis (DVT) and pulmonary embolism (PE), respectively. The rate of bleeding complications was 3.2%, but none of these patients required transfusion or hospital readmission for hemorrhage. The authors conclude that the described program for VTE prevention is a safe, effective, and practical program to administer prophylaxis to postoperative orthopaedic patients against clinically evident VTE for the first month after hospital discharge.
Reis
S E
SE
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115.
Hirsch
D R
DR
Wilson
M G
MG
Donovan
B C
BC
Goldhaber
S Z
SZ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics; D010351:Patient Discharge; D011183:Postoperative Complications / Q000517:prevention & control*; D011517:Prothrombin Time; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000517:prevention & control; D011859:Radiography; D012307:Risk Factors; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000517:prevention & control*; D013924:Thrombophlebitis / Q000000981:diagnostic imaging / Q000517:prevention & control; D014859:Warfarin / Q000008:administration & dosage
D014859:Warfarin