The National VTE Exemplar Centres Network response to implementation of updated <scp>NICE</scp> guidance: venous thromboembolism in over 16s: reducing the risk of hospital‐acquired deep vein thrombosis or pulmonary embolism (NG89)

Gee, Emma

doi:10.1111/bjh.16010

Cited by 53 publications

(25 citation statements)

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“…The 2018 National Institute for Health and Care Excellence (NICE) guideline recommended using anti-embolism stockings until discharge, combined with LMWH, as an option in patients undergoing elective TKA and THA [ 39 ]. For hip fracture, it is recommended to consider IPCD at the time of admission if pharmacological prophylaxis is contraindicated [ 39 ]. This should be continued until the patient no longer has significantly reduced mobility [ 39 ].…”

Section: Statements Of Group 3: Pharmacological Venous Thromboembolism Prophylaxismentioning

confidence: 99%

“…For hip fracture, it is recommended to consider IPCD at the time of admission if pharmacological prophylaxis is contraindicated [ 39 ]. This should be continued until the patient no longer has significantly reduced mobility [ 39 ].…”

Section: Statements Of Group 3: Pharmacological Venous Thromboembolism Prophylaxismentioning

confidence: 99%

“…The NICE guidelines were released in 2018 and recommended aspirin, LMWH, or rivaroxaban for patients undergoing elective knee replacement [ 39 ]. For patients undergoing elective hip replacement, the guidelines recommended LMWH or rivaroxaban [ 39 ]. For patients undergoing hip fracture surgery, LMWH or fondaparinux was recommended [ 39 ].…”

Section: Statements Of Group 3: Pharmacological Venous Thromboembolism Prophylaxismentioning

confidence: 99%

“…For patients undergoing elective hip replacement, the guidelines recommended LMWH or rivaroxaban [ 39 ]. For patients undergoing hip fracture surgery, LMWH or fondaparinux was recommended [ 39 ].…”

Section: Statements Of Group 3: Pharmacological Venous Thromboembolism Prophylaxismentioning

confidence: 99%

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Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 3. Pharmacological venous thromboembolism prophylaxis

Thiengwittayaporn

Budhiparama

Tanavalee

et al. 2021

Knee Surg & Relat Res

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Section: Statements Of Group 3: Pharmacological Venous Thromboembolism Prophylaxismentioning

confidence: 99%

Section: Statements Of Group 3: Pharmacological Venous Thromboembolism Prophylaxismentioning

confidence: 99%

Section: Statements Of Group 3: Pharmacological Venous Thromboembolism Prophylaxismentioning

confidence: 99%

Section: Statements Of Group 3: Pharmacological Venous Thromboembolism Prophylaxismentioning

confidence: 99%

See 2 more Smart Citations

Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 3. Pharmacological venous thromboembolism prophylaxis

Thiengwittayaporn

Budhiparama

Tanavalee

et al. 2021

Knee Surg & Relat Res

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“…16 For these reasons, the National Health Service in UK, and the corresponding authority in Sweden, have stressed the need for safer and more efficient VTE prophylaxis. [17][18][19] Mechanical thromboprophylaxis with intermittent pneumatic compression (IPC) reduces VTE is a costeffective intervention in hospitalised patients, and is recommended by guidelines for surgical in-hospital patients. 17 20 Whether long-term IPC treatment applied during leg immobilisation in an outpatient setting can reduce the incidence of DVT is unknown.…”

Section: Open Accessmentioning

confidence: 99%

STOP leg clots—Swedish multicentre trial of outpatient prevention of leg clots: study protocol for a randomised controlled trial on the efficacy of intermittent pneumatic compression on venous thromboembolism in lower leg immobilised patients

et al. 2021

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IntroductionLeg immobilisation in a cast or an orthosis after lower limb injuries is associated with a high risk of complications of venous thromboembolism (VTE) and hampered healing. Current pharmacoprophylaxes of VTE are inefficient and associated with adverse events. Intermittent pneumatic compression (IPC) could represent a novel, efficient and safe VTE-prophylactic alternative that may enhance injury healing. The aim of STOP leg clots is to assess the efficacy of adjuvant IPC-therapy on reduction of VTE incidence and improvement of healing in lower leg immobilised outpatients.Methods and analysisSTOP leg clots is a multicentre randomised controlled superiority trial. Eligible patients (700 patients/arm) with either an acute ankle fracture or Achilles tendon rupture will be randomised to either addition of IPC during lower-leg immobilisation or to treatment-as-usual. The primary outcome will be the total VTE incidence, that is, symptomatic and asymptomatic deep venous thrombosis (DVT) or symptomatic pulmonary embolism (PE), during the leg immobilisation period, approximately 6–8 weeks. DVT incidence will be assessed by screening whole leg compression duplex ultrasound at removal of leg immobilisation and/or clinically diagnosed within the time of immobilisation. Symptomatic PE will be verified by CT.Secondary outcomes will include patient-reported outcome using validated questionnaires, healing evaluated by measurements of tendon callus production and changes in VTE-prophylactic mechanisms assessed by blood flow and fibrinolysis. Data analyses will be blinded and based on the intention-to-treat.Ethics and disseminationEthical approval was obtained by the ethical review board in Stockholm, Sweden, Dnr 2016/1573-31. The study will be conducted in accordance with the Helsinki declaration. The results of the study will be disseminated in peer-reviewed international journals.Trial registrationNCT03259204.Time schedule1 September 2018 to 31 December 2022

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Venous Thromboembolism in Total Hip and Total Knee Arthroplasty

Simon,

Patell,

Zwicker

et al. 2023

JAMA Netw Open

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ImportanceThe optimal pharmacologic thromboprophylaxis agent after total hip and total knee arthroplasty is uncertain and consensus is lacking. Quantifying the risk of postoperative venous thromboembolism (VTE) and bleeding and evaluating comparative effectiveness and safety of the thromboprophylaxis strategies can inform care.ObjectiveTo quantify risk factors for postoperative VTE and bleeding and compare patient outcomes among pharmacological thromboprophylaxis agents used after total hip and knee arthroplasty.Design, Setting, and ParticipantsThis retrospective cohort study used data from a large health care claims database. Participants included patients in the United States with hip or knee arthroplasty and continuous insurance enrollment 3 months prior to and following their surgical procedure. Patients were excluded if they received anticoagulation before surgery, received no postsurgical pharmacological thromboprophylaxis, or had multiple postsurgery thromboprophylactic agents. In a propensity-matched analysis, patients receiving a direct oral anticoagulant (DOAC) were matched with those receiving aspirin.ExposuresAspirin, apixaban, rivaroxaban, enoxaparin, or warfarin.Main Outcomes and MeasuresThe primary outcome was 30-day cumulative incidence of postdischarge VTE. Other outcomes included postdischarge bleeding.ResultsAmong 29 264 patients included in the final cohort, 17 040 (58.2%) were female, 27 897 (95.2%) had inpatient admissions with median (IQR) length of stay of 2 (1-2) days, 10 948 (37.4%) underwent total hip arthroplasty, 18 316 (62.6%) underwent total knee arthroplasty; and median (IQR) age was 59 (55-63) years. At 30 days, cumulative incidence of VTE was 1.19% (95% CI, 1.06%-1.32%) and cumulative incidence of bleeding was 3.43% (95% CI, 3.22%-3.64%). In the multivariate analysis, leading risk factors associated with increased VTE risk included prior VTE history (odds ratio [OR], 5.94 [95% CI, 4.29-8.24]), a hereditary hypercoagulable state (OR, 2.64 [95% CI, 1.32-5.28]), knee arthroplasty (OR, 1.65 [95% CI, 1.29-2.10]), and male sex (OR, 1.34 [95% CI, 1.08-1.67]). In a propensity-matched cohort of 7844 DOAC-aspirin pairs, there was no significant difference in the risk of VTE in the first 30 days after the surgical procedure (OR, 1.14 [95% CI, 0.82-1.59]), but postoperative bleeding was more frequent in patients receiving DOACs (OR, 1.36 [95% CI, 1.13-1.62]).Conclusions and RelevanceIn this cohort study of patients who underwent total hip or total knee arthroplasty, underlying patient risk factors, but not choice of aspirin or DOAC, were associated with postsurgical VTE. Postoperative bleeding rates were lower in patients prescribed aspirin. These results suggest that thromboprophylaxis strategies should be patient-centric and tailored to individual risk of thrombosis and bleeding.

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The National VTE Exemplar Centres Network response to implementation of updated NICE guidance: venous thromboembolism in over 16s: reducing the risk of hospital‐acquired deep vein thrombosis or pulmonary embolism (NG89)

Cited by 53 publications

References 2 publications

Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 3. Pharmacological venous thromboembolism prophylaxis

Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 3. Pharmacological venous thromboembolism prophylaxis

STOP leg clots—Swedish multicentre trial of outpatient prevention of leg clots: study protocol for a randomised controlled trial on the efficacy of intermittent pneumatic compression on venous thromboembolism in lower leg immobilised patients

Venous Thromboembolism in Total Hip and Total Knee Arthroplasty

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