Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery.
BACKGROUND
Different guidelines exist regarding the prevention of venous thromboembolism (VTE) in orthopedic surgery.


OBJECTIVE
We aimed to compare (inter)national guidelines and analyse differences.


METHODS
MEDLINE, the Cochrane Library and the internet were searched for guidelines on the prevention of VTE in orthopedic surgery. From these, we constructed a table comparing the different antithrombotic regimens during different orthopedic surgical and plaster cast treatments.


RESULTS
Eleven guidelines from nine different countries and one international guideline were included. Few guidelines advise on thrombosis prophylaxis after plaster cast immobilization, (prolonged) arthroscopic surgery and isolated lower extremity trauma. Different opinions exist on the sole use of aspirin and mechanical prophylaxis and on the use of vitamin K antagonists after major hip and knee surgery.


CONCLUSIONS
Based on the same available literature, different guidelines recommend different thromboprophylactic regimens. Ideally, the grade of recommendation should be based on the same level of evidence world-wide. Whilst there is no agreement on the relevance of different endpoints (e.g. asymptomatic DVT), it is very difficult to reach a consensus. Thromboprophylaxis guidelines should be reviewed and updated on a regular basis, because the evidence is evolving rapidly.
Struijk-Mulder
M C
MC
Department of Orthopedic Surgery, Isala Clinics, Zwolle, the Netherlands.
Ettema
H B
HB
Verheyen
C C
CC
Büller
H R
HR
D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D001241:Aspirin / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002370:Casts, Surgical / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019983:Guideline Adherence; D006493:Heparin / Q000627:therapeutic use; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D007717:Knee / Q000601:surgery; D035002:Lower Extremity / Q000293:injuries / Q000601:surgery; D019637:Orthopedic Procedures / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors
D005343:Fibrinolytic Agents; D014812:Vitamin K; D006493:Heparin; D001241:Aspirin