Abstract

ASSESSMENT ORTHOPEDIC PATIENTS AT HIGH RISK FOR VENOUS THROMBOEMBOLISM DESPITE THROMBOPROPHYLAXIS IN MILITARY HOSPITAL

Ahmed Alamin Kazzam*, Ahmed Mustafa Khidir and Ali Awad Allah Ali Moh. Saeed

ABSTRACT

Introduction: Venous thromboembolism, including both deep-vein thrombosis and pulmonary embolism, is an important complication of major orthopedic surgery, and is associated with significant morbidity and mortality. A variety of factors related to the clinical setting and patient influence the risk of venous thromboembolism in orthopedic surgery patients. Objective: To assess orthopedic patients at high risk for venous thromboembolism despite thromboprophylaxis in military hospital. To evaluate risk factors for venous thromboembolism, Prevalence, Risk factors, Doses, Interaction, role of the clinical pharmacists, type of anticoagulation used, Compliance and Cost effectives. Material and method: This study was carried in military hospital Omdurman by a questionnaire for patients in December 2013 – January 2014 Study was conducted among Patients in risk of DVT in military hospital in Khartoum state. A pre designed and tested questionnaire were used for collect the data. Results: 40% from the patient’s undergone orthopedic surgeries were in age above 60 years, while 35% from patients were aged between 30-60 years. 76% from the patients were male while 73% from the patients were married. 97% from the patients were governmental employed. About their residence, 64% from the patients were rural. More than half from patients (67%), the orthopedic surgery was hip arthoplasty. The majority from the patients (82%) have surgical factors while 9% from the patients have patient’s related factors and the remaining have the both. 42% from patient has undergone orthopedic surgery, the thrombophrophylaxis drug given to them for less than 14 days. In the study, 38% from them the prophylaxis done by aspirin only while 4% done by physical prophylaxis (elastic stoking) and enoxaparin and this regimen does not match the guidelines. Only 52% from the orthopedic surgeries patients were given enoxaparin as thromboprophylactic agent, which matches the guidelines. Conclusion: Despite the availability of effective thromboprophylaxis, the prevention of venous thromboembolism in orthopedic surgery patients remains an important clinical problem. Because the increased risk of venous thromboembolism after orthopedic surgery can persist for several weeks, and discontinuation of anticoagulation therapy can lead to a second wave of thromboembolic complications, extended-duration thromboprophylaxis may be required during this period. Accurate prediction of thromboembolic risk in orthopedic patients should also facilitate the appropriate use of extended-duration thromboprophylaxis, thereby reducing the burden of venous thromboembolism. Improved risk-assessment models are therefore required to identify patients who will benefit from extended-duration thromboprophylaxis. The higher a patients risk of VTE, the greater the reliance on pharmacologic prophylaxis.

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