M Testroote1, W Morrenhof, H Janzing. 1. Department of Surgery and Orthopaedic Surgery, VieCuri Medisch Centrum voor Noord-Limburg, Venlo, The Netherlands.
Abstract
INTRODUCTION: Anticoagulant treatment might be used to prevent DVT and its complications in patients with leg immobilisation. METHODS: In April 2007, a questionnaire was sent to all 79 Dutch surgical and orthopaedic teaching hospitals and was used to obtain information in relation to use of thromboprophylaxis for patients with immobilisation for below-knee leg injuries in their department. RESULTS: A total of 79 questionnaires were sent, of which 69 were returned (response rate 88%). In total, 8 of the 69 departments never used thromboprophylaxis at all (12%), 27 of 61 (44%) only prescribed treatment in patients with a general elevated thrombosis risk. Nobody only treated specific injuries. Low molecular weight heparin was the most common agent by far, being prescribed in 95% of the cases. Also in 95% of the cases, the duration of treatment was the whole period of immobilisation. DISCUSSION: We aimed our survey at highlighting variation in practice among Dutch surgical and orthopaedic departments, regarding the use of thromboprophylaxis after immobilisation of the lower leg. We investigated the type of agent used, the timing and duration of the prophylaxis, and the use of a protocol. CONCLUSIONS: There is a substantial variation and inconsistency in practice among surgical and orthopaedic departments in the Netherlands due to different advices in clinical guidelines. Future guidelines should state a clear advice. Thromboprophylaxis is recommended by us for all patients with immobilisation for lower extremity injuries, irrespective of age and other risk factors. Further research is needed to evaluate cost effectiveness and the use of new thromboprophylactic agents.
INTRODUCTION: Anticoagulant treatment might be used to prevent DVT and its complications in patients with leg immobilisation. METHODS: In April 2007, a questionnaire was sent to all 79 Dutch surgical and orthopaedic teaching hospitals and was used to obtain information in relation to use of thromboprophylaxis for patients with immobilisation for below-knee leg injuries in their department. RESULTS: A total of 79 questionnaires were sent, of which 69 were returned (response rate 88%). In total, 8 of the 69 departments never used thromboprophylaxis at all (12%), 27 of 61 (44%) only prescribed treatment in patients with a general elevated thrombosis risk. Nobody only treated specific injuries. Low molecular weight heparin was the most common agent by far, being prescribed in 95% of the cases. Also in 95% of the cases, the duration of treatment was the whole period of immobilisation. DISCUSSION: We aimed our survey at highlighting variation in practice among Dutch surgical and orthopaedic departments, regarding the use of thromboprophylaxis after immobilisation of the lower leg. We investigated the type of agent used, the timing and duration of the prophylaxis, and the use of a protocol. CONCLUSIONS: There is a substantial variation and inconsistency in practice among surgical and orthopaedic departments in the Netherlands due to different advices in clinical guidelines. Future guidelines should state a clear advice. Thromboprophylaxis is recommended by us for all patients with immobilisation for lower extremity injuries, irrespective of age and other risk factors. Further research is needed to evaluate cost effectiveness and the use of new thromboprophylactic agents.