title: Physician compliance with guidelines for deep-vein thrombosis prevention in total hip and knee arthroplasty.
abstract: OBJECTIVE
  Despite evidence-based guidelines for venous thromboembolism (VTE) prevention after total hip or knee arthroplasty (THA/TKA), many patients may not receive effective prophylaxis. Our objective was to analyze data from the multinational Global Orthopaedic Registry (GLORY) to evaluate the compliance of surgeons with the American College of Chest Physicians (ACCP) guidelines for VTE prevention.
  
  
  METHODS
  Data from 8160 patients who had undergone a primary, unilateral, elective THA (n = 3950) or TKA (n = 4210), and had at least 3 months of follow-up were analyzed.
  
  
  RESULTS
  Almost all patients received a form of recommended prophylaxis. Compliance with guidelines in terms of type, duration, start time, and dose was achieved for 47% of THA and 61% of TKA patients in the USA, and 62% of THA and 69% of TKA patients outside the USA. Warfarin use, mostly in the USA, was fully compliant in 33% of THA and 48% of TKA patients. Low-molecular-weight heparin use was fully compliant in 63% of THA and 72% of TKA patients in the USA, and 67% of THA and 73% of TKA patients outside the USA.
  
  
  CONCLUSIONS
  Although almost all THA and TKA patients both inside and outside the USA received prophylaxis, a large proportion did not receive treatment in accordance with the ACCP guidelines. Our study may have overestimated the use of recommended prophylaxis as some participating investigators may have had a specific interest in VTE prophylaxis. Furthermore, although analyses were restricted to approximately three-quarters of patients who had outpatient follow-up data, their characteristics were similar to those in the entire population.
authors.affiliation: Charleston Orthopedic Associates, Charleston, SC 29414, USA. rjfriedman@mybones.com
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Friedman
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Gallus
authors.forename: Fred D
authors.initials: FD
authors.lastname: Cushner
authors.forename: Gordon
authors.initials: G
authors.lastname: Fitzgerald
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006287:Health Planning Guidelines; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D012955:Societies, Medical; D054556:Venous Thromboembolism / Q000517:prevention & control; D020246:Venous Thrombosis / Q000517:prevention & control*