Mandated venous thromboembolism prophylaxis: possible adverse outcomes.
The purpose of this study was to assess the prevalence and seriousness of adverse outcomes owing to mandatory venous thromboembolism (VTE) prophylaxis. A retrospective study of administrative claims data was conducted to look at the rate of VTEs and other complications in patients undergoing hip and knee arthroplasty. Additional analysis was done to determine whether patient characteristics could explain findings. Although rates of VTE remain unchanged from 2003 to 2007, the rate of immediate postprocedure hematoma, seroma, and hemorrhage went from 1.4% in 2003 to 9.6% in 2006. Return to a more conservative prophylaxis approach resulted in a marked decrease in rates of significant bleeding events. Although preventing VTEs is an important quality concern, mandating prophylaxis for all patients could have unintended adverse outcomes. These guidelines might need to be reevaluated for hip and knee arthroplasty patients.
Novicoff
Wendy M
WM
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
Brown
Thomas E
TE
Cui
Quanjun
Q
Mihalko
William M
WM
Slone
Harris S
HS
Saleh
Khaled J
KJ
D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D005500:Follow-Up Studies; D017408:Guidelines as Topic / Q000592:standards; D006470:Hemorrhage / Q000139:chemically induced; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D054556:Venous Thromboembolism / Q000517:prevention & control*; D014859:Warfarin / Q000009:adverse effects
D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin