title: The use of warfarin as thromboprophylaxis for lower limb arthroplasty.
abstract: BACKGROUND
  Most orthopaedic surgeons in the UK use some form of prophylaxis against venous thromboembolic events. Warfarin has been recommended as one of the preferred methods to use. The period of in-hospital postoperative rehabilitation has reduced significantly since lower limb arthroplasty was introduced. We sought to identify and quantify any delay in discharge associated in using warfarin as chemical prophylaxis.
  
  
  METHODS
  During a 12-week period, all patients undergoing a lower limb arthroplasty procedure were identified and any delay in discharge related to their warfarin prophylaxis was recorded.
  
  
  RESULTS
  Of the 25 arthroplasties performed in this time period, 17 (68%) were subject to a delay. The total delay in discharge was 39 days. When the standard warfarin dosing protocol was followed, 33% of patients were still delayed. When the protocol was not followed, only 23% were delayed. The majority of deviations from the protocol led to a shorter hospital stay.
  
  
  CONCLUSIONS
  Patients using warfarin prophylaxis generate an additional cost of 417 pounds related to bed occupancy. There is considerable scope for significantly reducing this cost by moving the early postoperative anticoagulation monitoring into the community. Delayed discharge is an important consideration in the economic issues that surround the choice of thromboprophylaxis.
authors.affiliation: Academic Department of Orthopaedics, Warwick Medical School, Clinical Sciences Research Institute, University Hospital, Coventry, UK. mdunbar@btinternet.com
authors.forename: Mark R
authors.initials: MR
authors.lastname: Dunbar
authors.forename: Piyush K
authors.initials: PK
authors.lastname: Upadhyay
authors.forename: Shanmugam
authors.initials: S
authors.lastname: Karthikeyan
mesh_terms: D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000191:economics; D002985:Clinical Protocols; D003365:Costs and Cost Analysis; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*; D013923:Thromboembolism / Q000191:economics / Q000517:prevention & control*; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin