Opportunities for improvement: anticoagulation in patients undergoing total knee or hip replacement

BACKGROUND: According to guidelines, initiation of pharmacological thromboprophylaxis after total knee or hip replacement is recommended and associated with improved patient outcomes. However, data on how these recommendations are followed in clinical practice are sparse.

METHODS: All patients undergoing first-time total knee or hip replacement in Denmark 2008-2011 were identified. By cross-referencing Danish nationwide registries, quantitative use of anticoagulants administered orally and subcutaneously post-discharge was assessed by number of claimed prescriptions after surgery. Logistic regression analysis was used to identify factors associated with initiation of prophylaxis.

RESULTS: A total of 50,389 patients were included in the study (median age 69, inter-quartile range 62-76). Novel oral anticoagulants were initiated in 14.7 % of the patients and heparins/fondaparinux in 2.3 % of the patients. The use of anticoagulants increased from 6.3 % in 2008 to 30.0 % of patients in 2011. Among patients initiating prophylaxis with a novel oral anticoagulant post-discharge, almost all were treated according to guidelines in terms of treatment duration. Factors significantly associated with an increased chance of prophylaxis among total hip replacement patients were: age (per 10-year increments) and female gender.

CONCLUSIONS: Use of pharmacological thromboprophylaxis after total knee or hip replacement was low, but increasing during the study period. This is probably due to increased availability of novel oral anticoagulants. Further initiatives to increase guideline recommended use of prophylactic anticoagulation after orthopaedic surgery are warranted.