Chest
Clinical Investigations: VENOUS THROMBOEMBOLISMIdentifying Orthopedic Patients at High Risk for Venous Thromboembolism Despite Thromboprophylaxis
Section snippets
MATERIALS AND METHODS
Charts from all patients who underwent THR, TKR, or HFS (pinning or hemiarthroplasty) at our institution between August 1, 1999, and April 30, 2000, were retrieved and systematically reviewed using a standardized case report form. Patients who did not receive LMWH at the standard VTE prophylaxis dose as recommended by the thromboprophylaxis regimen for orthopedic surgery patients at our institution (see below) were excluded. Data were collected on baseline patient characteristics, type and side
RESULTS
Between August 1, 1999, and April 30, 2000, 385 patients were admitted to the Orthopedic Service for major orthopedic surgery. Of these, 75 patients were excluded because review of their charts showed that they did not receive the standard dose of LMWH for thromboprophylaxis, they did not receive any thromboprophylaxis, or they did not undergo surgery.
DISCUSSION
We studied the incidence and predictors of symptomatic breakthrough VTE in patients undergoing orthopedic surgery at a large tertiary care hospital. We found that the rate of symptomatic VTE was high, and that knee surgery and type of LWMH used for prophylaxis independently predicted symptomatic breakthrough VTE. Patient characteristics, operative factors, and traditional VTE risk factors were not independently associated with VTE in our study patients.
Our study consisted of a typical patient
ACKNOWLEDGMENTS
We thank Ms. Rosalie Johnson, RN, for administrative assistance.
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Drs. Kahn and Shrier are recipients of Clinical Investigator Awards from the Fonds de la Recherche en Santeí du Queíbec. This study was funded in part by an unrestricted grant-in-aid from Aventis to Dr. S. Kahn. The study sponsor had no role in the design and conduct of the study, the collection, management, analysis, interpretation and reporting of study data, the writing of the manuscript or the decision to submit the manuscript for publication.
This work was presented in part, as an abstract, at the Canadian Society of Internal Medicine Annual Meeting, Quebec City, Canada, June 2004.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).