June 2, 2008 Fewer than 1 in 5 patients received post-discharge therapy to prevent life-threatening blood clots -- venous thrombosis -- after hip- or knee-replacement surgery, report Rahme and colleagues in a retrospective cohort study. Venous thrombosis is one of the leading causes of death among hospital patients. However, elderly patients have a 70% lower chance of dying within 3 months if they take an anticoagulant drug to prevent blood clots.
Hip and knee replacement surgery patients -- who are often elderly -- are at increased risk of developing potentially life-threatening thrombosis, or blood clots. Nevertheless, according to a study by Dr. Elham Rahme of the Research Institute of the McGill University Health Centre (RI-MUHC) and McGill University, most patients in Quebec do not receive the recommended treatment to prevent a thrombosis.
Dr. Rahme and her team analyzed the records of 7,058 Quebec hip and knee replacement patients, and discovered that only 19 percent of them received post-discharge antithrombotic treatment. The percentage varied somewhat between different hospitals and different lengths of hospital stay, but in almost all cases it remained well below official guidelines, which recommend at least 10 days, and up to 35 days, of treatment after surgery.
Although mortality risk following hip and knee replacement surgery is low, it increases for patients who do not receive antithrombotic treatment after leaving the hospital, the researchers said.
"This study is only the first step in a vast project on thrombosis related to hip and knee replacements. We have now determined the number of antithrombotic drug prescriptions in Quebec; our next step will consist in recruiting patients to analyze how well their prescribed antithrombotic treatments correspond to their medical conditions," Dr. Rahme explained.
It's unknown why antithrombotic drugs are so consistently underused, but concern about potential side-effects, particularly in the elderly, is one possibility. Nevertheless, the researchers said, this could not fully explain the huge gap between official treatment guidelines and the clinical realities revealed by this study.
The study will be published June 3 in the Canadian Medical Association Journal.
This study was supported by the Canadian Institutes of Health Research (CIHR).
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