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Venous Thromboembolism

Venous thromboembolism (VTE) poses a significant risk in orthopaedic surgeries, accounting for approximately 25,000 deaths annually in the UK. With 40-60% of joint replacements associated with VTE, the risk of fatal pulmonary embolism (PE) ranges from 0.1% to 5%. Despite varying adherence to thromboprophylaxis, there is an increasing incorporation of both mechanical and chemical prevention methods. Understanding the nuances of VTE risk assessment, particularly for hip and knee replacements, is crucial. Expert guidance and continued audits are essential as practices evolve.

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Venous Thromboembolism

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  1. An Orthopod’s Perspective Venous Thromboembolism Adrian Beaumont Consultant Orthopaedic Surgeon Salisbury District Hospital

  2. Size of Problem • ? 25,000 deaths per year • VTE in 40% to 60% joint replacements • Fatal PE in 0.1% to 5% • Inconsistent thromboprophylaxis • Joint registry shows increasing use of mechanical and chemical methods

  3. Hugh Owen Thomas 1834 - 1891

  4. Fast Track Mobilisation • No clear data on VTE risk • Intuitively beneficial

  5. Rudolf Virchov 1821 - 1902

  6. Nice Guidelines 2010 • Had orthopaedic input • Risk assess • Hip and knee replacements high risk • Combined methods • Oral agents (not aspirin) • Duration • ‘Opt out’ when bleeding risk

  7. Evidence! Or Evidence? Cross trial comparisons • Criteria • End points • Definitions • Sponsored? • Statistics Need Expert Interpretation

  8. Anti-Embolism Stockings • Often problematic for our patients • Wounds, swelling etc • Restricted movement • Large legs

  9. Hip Fractures • Very common • High mortality • Immobility • Delay to theatre • Age

  10. Lower Limb Casts • Evidence if risk • ? UK lags behind Europe • Risk assess or risk forgetting • Plymouth type scoring system • LMWH prescribed at discretion • Ongoing audit

  11. Major Bleeding (EMEA) • Fatal Bleeding • Decrease Hb by 20 grams • Transfusion 2 units blood • Critical bleeding • Leading to discontinuation • At surgical site • Leading to reoperation

  12. Deep Infection Often disastrous Usually means implant removal

  13. Summary • The importance VTE recognised • We have some knowledge of efficacy • Variable but increasing prophylaxis • The adverse effects must be considered • Expert guidance needed • There will be ongoing change

  14. Thank You

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