ISSN: 1859 - 2872
Guideline adherence for post-discharge venous thromboembolism prophylaxis prescribing in major orthopedic surgery patients at Saint Paul General Hospital
Main Article Content
Keywords
Prophylaxis, venous thromboembolism, major orthopedic surgery, discharge prescription.
Abstract
Objective: To evaluate adherence to the institutional guideline regarding post-discharge venous thromboembolism prophylaxis prescribing practices among patients undergoing major orthopedic surgery (MOS). Subject and method: A retrospective, cross-sectional study was conducted on all patients undergoing MOS in the Orthopedic Trauma departments at Saint Paul General Hospital from April 8, 2026 to June 8, 2026. Result: Among 94 included MOS patients, 96,8% (91/94) were prescribed post-discharge VTE pharmacological prophylaxis, with rivaroxaban 10mg being the sole anticoagulant agent used. The adherence rate for drug selection was 62.6%; with non-adherence case exclusively attributed to inappropriate DOAC use in femoral fracture patients. Among patients with appropriate drug selection, adherence to dosing regimens reached 100%. The mean total duration of prophylaxis was 29.6 ± 5.6 days, and 100% of patients achieved the minimum recommended duration. However, only 66.7% achieved the optimal recommended duration. Conclusion: Post-discharge venous thromboembolism (VTE) prophylaxis prescribing practice achieved high adherence rates regarding indication, dosing regimen, and minimum duration following the implementation of the guideline; however, gaps remain regarding drug selection in the femoral fracture cohort and optimal duration of prophylaxis, necessitating the continued implementation of clinical pharmacy interventions.
Article Details
References
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13. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S et al (2012) Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl): 278S- 325S.
14. NICE (2018) Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. NICE guideline.
15. Schunemann HJ, Cushman M, Burnett AE, Kahn SR, Beyer-Westendorf J, Spencer FA et al (2018) American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv 2(22): 3198-3225.
16. Long NĐ, Trang NHQ, Hoa TTT (2025) Thực hành dự phòng thuyên tắc huyết khối tĩnh mạch trên bệnh nhân phẫu thuật chỉnh hình tại Bệnh viện Đa khoa Xanh Pôn. Tạp chí Y Dược Lâm sàng 108, tr. 176-183.
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18. van Oosterom N, Barras M, Cottrell N (2024) Prevention of venous thromboembolism after total hip and knee arthroplasties in Australian hospitals: What are we using? J Pharm Pract Res 54(4): 287-295.
19. ICM-VTE Trauma Delegates (2022) Recommendations from the ICM-VTE: Trauma. J Bone Joint Surg Am 104(1): 280-308.
20. Guillermo Bonilla, Adolfo Llinás, Alfredo Sánchez, Sergio Monsalve, Gustavo Matson, Etna Liliana Valenzuela (2019) Adherencia a las guías internacionales de tromboprofilaxis en pacientes sometidos a cirugía ortopédica mayor en Colombia: Resultados del Registro DEIMOS. Rev Colomb Ortop Traumatol 33(3-4): 89-97.
21. Samama CM, Afshari A, Gronlykke L, Madsen MH, Wiberg S, Romero CS (2024) European guidelines on peri-operative venous thromboembolism prophylaxis: first update: Executive summary. Eur J Anaesthesiol 41(8): 561-569.
22. O'Connor MI, Switzer JA (2022) AAOS Clinical Practice Guideline Summary: Management of Hip Fractures in Older Adults. J Am Acad Orthop Surg 30(20): 1291-1296.
23. Nicolaides AN, Fareed J, Spyropoulos AC, Kakkar RHL, Antignani PL, Avgerinos E et al (2024) Prevention and management of venous thromboembolism. International Consensus Statement. Guidelines according to scientific evidence. Int Angiol 43(1): 1-222.
24. Nederpelt CJ, Bijman Q, Krijnen P, Schipper IB (2022) Equivalence of DOACS and LMWH for thromboprophylaxis after hip fracture surgery: Systematic review and meta-analysis. Injury 53(3): 1169-1176.
25. Abatzis-Papadopoulos M, Tigkiropoulos K, Nikas S, Papoutsis I, Kostopoulou O, Stavridis K et al (2023) The effectiveness and safety of direct oral anticoagulants compared to conventional pharmacologic thromboprophylaxis in hip fracture patients: A systematic review and meta-analysis of randomized controlled trials. Orthop Traumatol Surg Res 109(2): 103364.
26. Salazar CA, Basilio Flores JE, Malaga G, Malasquez GN, Bernardo R (2025) Direct factor Xa inhibitors versus low molecular weight heparins or vitamin K antagonists for prevention of venous thromboembolism in elective primary hip or knee replacement or hip fracture repair. Cochrane Database Syst Rev 1(1): CD011762.
27. Ghazi FG, Schenker ML, Smith RN, Spencer CC, Mlaver E (2024) Patient-reported barriers for adherence to prophylactic enoxaparin after orthopedic trauma surgery. Injury 55(8): 111650.
28. Wilke T, Moock J, Müller S, Pfannkuche M, Kurth A (2010) Nonadherence in outpatient thrombosis prophylaxis with low molecular weight heparins after major orthopaedic surgery. Clin Orthop Relat Res 468(9): 2437-2453.
29. Doan TMD, Le C (2026) Nghiên cứu tình hình sử dụng thuốc dự phòng thuyên tắc huyết khối tĩnh mạch trên bệnh nhân phẫu thuật chỉnh hình chi dưới tại Bệnh viện Đà Nẵng. Tạp chí Y Dược Huế (S-1): 220-229.
30. Najjar PA, Madenci AL, Zogg CK, Schneider EB, Dankers CA, Pimentel MT et al (2016) Implementation of a Comprehensive Post-Discharge Venous Thromboembolism Prophylaxis Program for Abdominal and Pelvic Surgery Patients. J Am Coll Surg 223(6): 804-813.
2. Lutsey PL, Zakai NA (2023) Epidemiology and prevention of venous thromboembolism. Nat Rev Cardiol 20(4): 248-262.
3. Santana DC, Emara AK, Orr MN, Klika AK, Higuera CA, Krebs VE, et al (2020) An Update on Venous Thromboembolism Rates and Prophylaxis in Hip and Knee Arthroplasty in 2020. Medicina (Kaunas) 56(9).
4. Eikelboom JW, Quinlan DJ, Douketis JD (2021) Extended-duration prophylaxis against venous thromboembolism after total hip or knee replacement: A meta-analysis of the randomised trials. Lancet 358(9275): 9-15.
5. Gao Y, Long A, Xie Z, Meng Y, Tan J, Lv H et al (2016) The compliance of thromboprophylaxis affects the risk of venous thromboembolism in patients undergoing hip fracture surgery. Springerplus 5(1): 1362.
6. Gurunathan U, Bright M, Mullany D, Judd M, Hay K, Nandurkar H, Eley V (2026) Impact of extended duration pharmacological thromboprophylaxis on venous thromboembolism after hip and knee arthroplasty and hip fracture surgery: A systematic review and meta-analysis of randomised controlled trials. J Thromb Thrombolysis 59(1): 5-22.
7. Queensland Health Guideline (2018) Guideline for the prevention of Venous Thromboembolism (VTE) in adult hospitalised patients. Queensland Government.
8. Bộ Y tế (2023) Hướng dẫn điều trị dự phòng thuyên tắc huyết khối tĩnh mạch. Cục Quản lý và Khám chữa bệnh.
9. Arcelus JI, Felicissimo P (2013) DEIMOS Investigators. Venous thromboprophylaxis duration and adherence to international guidelines in patients undergoing major orthopaedic surgery: Results of the international, longitudinal, observational DEIMOS registry. Thromb Res 131(6): 240-266.
10. Kayali F, Nautiyal H, Topping J, Ong CT, Ahmed EM, Sharrock M (2025) Prescription of Pharmacologic Venous Thromboembolism Prophylaxis Upon Hospital Discharge After Surgery for Lower Limb Fracture-A 3-Center Study in the North-West of England. Clin Ther 47(7): 1- 5.
11. Jones B, Patil S, Smith J (2024) Clinical guideline: Thromboprophylaxis for Orthopaedic Patients Admitted to Hospital (Adults). Glasgow: NHS Greater Glasgow and Clyde Contract No: Version 5.
12. Farfan M, Bautista M, Bonilla G, Rojas J, Llinás A, Navas J (2016) Worldwide adherence to ACCP guidelines for thromboprophylaxis after major orthopedic surgery: A systematic review of the literature and meta-analysis. Thromb Res 141: 163-170.
13. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S et al (2012) Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl): 278S- 325S.
14. NICE (2018) Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. NICE guideline.
15. Schunemann HJ, Cushman M, Burnett AE, Kahn SR, Beyer-Westendorf J, Spencer FA et al (2018) American Society of Hematology 2018 guidelines for management of venous thromboembolism: prophylaxis for hospitalized and nonhospitalized medical patients. Blood Adv 2(22): 3198-3225.
16. Long NĐ, Trang NHQ, Hoa TTT (2025) Thực hành dự phòng thuyên tắc huyết khối tĩnh mạch trên bệnh nhân phẫu thuật chỉnh hình tại Bệnh viện Đa khoa Xanh Pôn. Tạp chí Y Dược Lâm sàng 108, tr. 176-183.
17. Thuy Nguyen, My Le, Trung Nguyen, Huong Nguyen (2025) Surgeons’ practices and perceptions regarding postoperative venous thromboprophylaxis for patients undergoing major orthopedic surgery at 108 Military Central Hospital. Journal of Pharmaceutical Reasearch and Drug Information: 22.
18. van Oosterom N, Barras M, Cottrell N (2024) Prevention of venous thromboembolism after total hip and knee arthroplasties in Australian hospitals: What are we using? J Pharm Pract Res 54(4): 287-295.
19. ICM-VTE Trauma Delegates (2022) Recommendations from the ICM-VTE: Trauma. J Bone Joint Surg Am 104(1): 280-308.
20. Guillermo Bonilla, Adolfo Llinás, Alfredo Sánchez, Sergio Monsalve, Gustavo Matson, Etna Liliana Valenzuela (2019) Adherencia a las guías internacionales de tromboprofilaxis en pacientes sometidos a cirugía ortopédica mayor en Colombia: Resultados del Registro DEIMOS. Rev Colomb Ortop Traumatol 33(3-4): 89-97.
21. Samama CM, Afshari A, Gronlykke L, Madsen MH, Wiberg S, Romero CS (2024) European guidelines on peri-operative venous thromboembolism prophylaxis: first update: Executive summary. Eur J Anaesthesiol 41(8): 561-569.
22. O'Connor MI, Switzer JA (2022) AAOS Clinical Practice Guideline Summary: Management of Hip Fractures in Older Adults. J Am Acad Orthop Surg 30(20): 1291-1296.
23. Nicolaides AN, Fareed J, Spyropoulos AC, Kakkar RHL, Antignani PL, Avgerinos E et al (2024) Prevention and management of venous thromboembolism. International Consensus Statement. Guidelines according to scientific evidence. Int Angiol 43(1): 1-222.
24. Nederpelt CJ, Bijman Q, Krijnen P, Schipper IB (2022) Equivalence of DOACS and LMWH for thromboprophylaxis after hip fracture surgery: Systematic review and meta-analysis. Injury 53(3): 1169-1176.
25. Abatzis-Papadopoulos M, Tigkiropoulos K, Nikas S, Papoutsis I, Kostopoulou O, Stavridis K et al (2023) The effectiveness and safety of direct oral anticoagulants compared to conventional pharmacologic thromboprophylaxis in hip fracture patients: A systematic review and meta-analysis of randomized controlled trials. Orthop Traumatol Surg Res 109(2): 103364.
26. Salazar CA, Basilio Flores JE, Malaga G, Malasquez GN, Bernardo R (2025) Direct factor Xa inhibitors versus low molecular weight heparins or vitamin K antagonists for prevention of venous thromboembolism in elective primary hip or knee replacement or hip fracture repair. Cochrane Database Syst Rev 1(1): CD011762.
27. Ghazi FG, Schenker ML, Smith RN, Spencer CC, Mlaver E (2024) Patient-reported barriers for adherence to prophylactic enoxaparin after orthopedic trauma surgery. Injury 55(8): 111650.
28. Wilke T, Moock J, Müller S, Pfannkuche M, Kurth A (2010) Nonadherence in outpatient thrombosis prophylaxis with low molecular weight heparins after major orthopaedic surgery. Clin Orthop Relat Res 468(9): 2437-2453.
29. Doan TMD, Le C (2026) Nghiên cứu tình hình sử dụng thuốc dự phòng thuyên tắc huyết khối tĩnh mạch trên bệnh nhân phẫu thuật chỉnh hình chi dưới tại Bệnh viện Đà Nẵng. Tạp chí Y Dược Huế (S-1): 220-229.
30. Najjar PA, Madenci AL, Zogg CK, Schneider EB, Dankers CA, Pimentel MT et al (2016) Implementation of a Comprehensive Post-Discharge Venous Thromboembolism Prophylaxis Program for Abdominal and Pelvic Surgery Patients. J Am Coll Surg 223(6): 804-813.
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Published
Oct 19, 2026
Section
Articles
How to Cite
TrangN. H. Q. (2026). Guideline adherence for post-discharge venous thromboembolism prophylaxis prescribing in major orthopedic surgery patients at Saint Paul General Hospital. Tạp Chí Y Dược lâm sàng 108, 21. https://doi.org/10.52389/ydls.v21i0.3238