title: Real life thromboprophylaxis in orthopedic surgery in Italy. Results of the GIOTTO study.
abstract: BACKGROUND
  Data from a prospective, multicentre observational study (Studio GIOTTO) were analyzed to determine, in clinical practice, the pattern of VTE prophylaxis and adherence to international guidelines recommendations in major orthopedic surgery (MOS) - including total hip arthroplasty (THA), total knee arthroplasty (TKA) and hip fracture surgery (HFS) - and knee arthroscopic surgery (KAS).
  
  
  METHODS
  In 2010, the first consecutive 30 patients hospitalized in Italian centers for MOS and the first 15 for KAS were enrolled and treated according to the usual practice.
  
  
  RESULTS
  2010 patients were admitted for MOS (577 TKA, 787 THA and 646 HFS) and 993 for KAS; mean ± SD age was 71.7 ± 8 and 43.0 ± 15 years, and female prevalence was 65.6% and 31.1% in MOS and KAS, respectively. Most (66.7%; 95% CI: 65-69%) patients admitted for MOS received a combined VTE prophylaxis, consisting of both pharmacological and physical tools, and 33.2% (95% CI: 31-35%) only pharmacological. For KAS figures were 23.7 (95% CI: 21-26%) and 75.3% (95% CI: 72-77%). Most MOS (91%; 95% CI: 89-92%) and KAS (95% CI: 98-100%) patients receiving pharmacological thromboprophylaxis were treated with low molecular weight heparin (LMWH), for (median) 40 days in TKR, 39 days in THR, 44 in HFS, and 16 in KAS. Patients receiving <35 days of LMWH prophylaxis among those undergoing THR and HFS were 8.9% and 5.9%, respectively.
  
  
  CONCLUSIONS
  Although most patients undergoing orthopedic surgery received VTE prophylaxis, a gap between clinical practice and international guideline recommendations was observed. The reduced adherence to guideline recommendations is relevant for certain choices like type and duration of VTE, and physicians' behavior may reflect the changing approach of guidelines in their different editions.
authors.affiliation: IRCCS, Policlinico San Donato, San Donato Milanese, Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Randelli
authors.affiliation: Department of Medicine, Vimercate Hospital Azienda Ospedaliera di Desio e Vimercate, Vimercate, Italy. Electronic address: claudio.cimminiello@aovimercate.org.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cimminiello
authors.affiliation: Department of Orthopedics, Santa Maria Hospital, Bari, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Capozzi
authors.affiliation: Anesthesiology and Intensive Care Unit, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Bosco
authors.affiliation: Institute of Orthopedic and Traumatology, "Agostino Gemelli" Hospital, Catholic University, Rome, Italy; Institute of Translational Research for Musculoskeletal System "Nicola Cerulli", Arezzo, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Cerulli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011292:Premedication / Q000592:standards* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight
keywords: Heparin, low-molecular-weight; Observational study; Orthopedics; Prophylaxis; Surgical procedures, operative; Venous thromboembolism