MULTINATIONAL ORTHOPEDIC SURGEONS SURVEY ON THROMBOPROPHYLAXIS AND PERCEPTIONS OF BLEEDING EVENTS IN TOTAL HIP REPLACEMENT AND TOTAL KNEE ARTHROPLASTY

Abstract

Introduction: Though underutilized, there are currently several pharmacological options available for the prevention of venous thromboembolism (VTE) following major orthopedic surgery. The use of different agents depends on the orthopedic surgeon’s perception of the benefit in prevention of thrombosis versus the risk of bleeding, as well as the bleeding origin (surgical or not). Here we report the results of an international survey assessing the orthopedic surgeon’s perception of the importance of different types of bleeding and how these relate to the bleeding endpoints used in clinical trials.

Methods: Orthopedic surgeons from Germany, Spain, France, USA, and the UK were invited to participate in this survey. Each responder was asked 13 questions. The answers provided by the first 100 responders from each country were used in subsequent analyses. Once 100 surveys had been completed in each country, no further data were collected. Only in France, the physicians invited to participate also included anesthetists, therefore data from this country were obtained from 50 orthopedic surgeons and 50 anesthetists. In all other countries the physicians invited were exclusively orthopaedic surgeons.

Results: In total, 5303 physicians from across Germany, Spain, France, USA, and the UK were invited to participate in the survey. Of these, 789 responded to the invitation. Surgical site bleedings were a great concern in 50–71% of surgeons across participating countries whereas a lower proportion of surgeons appeared to be concerned regarding extra surgical bleeding (2–11%). Importantly, up to 79% and 71% of surgeons across participating countries considered an increase in surgical site bleeding to be very likely associated with a longer hospital stay and delay or difficulty in postoperative rehabilitation, respectively. When asked to decide between anticoagulant A with reduced bleeding risk (versus current agents with similar efficacy) and a second agent (anticoagulant B), which was associated with increased prophylactic efficacy (versus current agents with similar bleeding rate), 52–67% of responders reported that they would select anticoagulant A.

Conclusions: Our survey suggests that surgical site bleedings are of major concern among surgeons across different countries. Up to approximately 80% of surgeons consider that an increase in surgical site bleedings has an impact on patients’ duration of hospitalization and rehabilitation process. Reduced risk for bleeding may be considered a more important factor compared with an increase in efficacy among orthopedic surgeons, when determining the choice of anticoagulant prophylaxis.