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Standardized Thromboembolism Prophylaxis in Orthopedic Patients to Prevent Venous
ThromboEmbolism Study: A Novel Prospectively Validated Electronic Risk
Stratification Tool for Elective Hip and Knee Joint Replacement Patients
#MMPMID41185852
Woller SC
; Stevens SM
; Wylie JD
; Layne B
; Dong L
; Lloyd JF
; Momberger NG
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41185852
show ga
BACKGROUND: Venous thromboembolism (VTE) includes pulmonary embolism (PE), and
deep vein thrombosis (DVT) and is a complication of total hip and knee (THR/TKR)
joint replacement surgery. Guidelines historically recommended anticoagulation
thromboprophylaxis for patients undergoing elective THR/TKR, and aspirin has
emerged as an alternative for select patients. VTE risk stratification may
identify patients who can safely receive aspirin. Limited evidence informs how to
risk-stratify THR/TKR patients, then recommend risk-stratified
thromboprophylaxis. METHODS: We derived and implemented "Standardized
Thromboembolism Prophylaxis in Orthopedic Patients to prevent Venous
ThromboEmbolism (STOP-VTE)," an evidence-based electronic heath record embedded
VTE risk assessment model in our 23-hospital-integrated health system. The model
classified patients as at high or standard risk of VTE and recommended
anticoagulation (mostly apixaban 2.5 mg twice daily for 28 days) or aspirin (81
mg twice daily) prophylaxis, respectively. The primary implementation outcome for
this prospective management study was adherence to STOP-VTE guidance, and the
primary clinical outcome was VTE. Among 38,207 consecutive patients, we recorded
surgeon adherence to STOP-VTE guidance and outcome rates of 90-day VTE, PE, DVT,
mortality, and rates of 30-day major bleeding, emergency department visits, and
hospitalization. Outcomes were recorded for 2 years preceding implementation of
STOP-VTE (baseline) and for 6.8 years after STOP-VTE implementation
(intervention). RESULTS: For the primary implementation outcome during the
baseline period, 57.4% (1,467/2,554) received aspirin or anticoagulant
prophylaxis consistent with risk classification, and during the intervention,
this rate increased to 77.8% (27,744/35,653; p < 0.001). Clinical outcome rates
at baseline vs. intervention were the following: for 90-day VTE, 0.9% vs. 0.65%;
PE, 0.7% vs. 0.39%; DVT, 0.31% vs. 0.29%; and mortality, 0.16% vs. 016%.
Thirty-day major bleeding was 0% vs. 0.04%; emergency department and
rehospitalization rates were 6.97% vs. 5.31% and 2.45% vs. 1.71%, respectively.
Pulmonary embolism, emergency department, and hospitalization visit rates
significantly declined. CONCLUSION: STOP-VTE guidance was implemented and broadly
adopted. Adherent chemoprophylaxis was associated with low rates of 90-day VTE,
major bleeding, decrease in anticoagulant chemoprophylaxis, increase in aspirin
chemoprophylaxis, and cost savings. LEVEL OF EVIDENCE: Therapeutic Level II. See
Instructions for Authors for a complete description of levels of evidence.
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