A STUDY OF CURRENT THROMBOPROPHYLATIC PRACTICES OF SCOTTISH ORTHOPAEDIC SURGEONS IN PATIENTS UNDERGOING TOTAL HIP REPLACEMENTS.

Abstract

Despite increasing scientific investigation, the best method for preventing post-operative deep vein thrombosis remains unclear in patients undergoing a total hip replacement. In the wake of the recent controversial National Institute for Health and Clinical Excellence Clinical Guidelines on the prevention of thrombo-embolism, we felt it was timely to survey current Scottish Surgeons thrombo-prophylactic practice when performing total hip replacements.

E-mail questionnaires were sent to all Scottish Orthopaedic consultants. They were asked about routine pharmacological and mechanical prophylaxis in patients undergoing total hip replacement. Comparison was made with a previous survey done in 2003.

The response rate was 75%. The survey showed an increased use of pharmacological prophylaxis from 93% to 100%. This was due to the increased use of aspirin, from 51% to 64%. The use of Low molecular weight heparin had remained the same at 51%. No surgeons routinely use Warfarin, low dose heparin or Fondaparinux. Use of graded compression stockings has increased from 59% to 70%.

There is increasing evidence that patients undergoing total hip replacement should receive extended prophylaxis for up to 35 days. This could explain why aspirin is commonly used. Most guidelines, however, do not recommend this drug. With the recent launch of two new oral agents we may see a huge change in prophylaxis in Scotland, as 94% of surgeons said they would use extended prophylaxis if a safe oral agent was found.