Assessment of the adequacy of the prevention of thromboembolic complications in patients after major orthopedic operations in ukraine (study ENOVA)

Abstract

Among the complications occurring in patients after severe orthopedic surgeries the most dangerous stuff for life is venous thromboembolism the likelihood of which persists for several weeks after leaving of inpatient department. However, over 40 % of patients with an increased risk of venous thromboembolic complications (VTEC) do not receive any preventive treatment. In Ukraine there was conducted the first multicentre non-interventional observational study ENOVA on analysis of prevention of VTEC after major orthopedic operations. Primary objective: to compare the actual duration of pharmacological prophylaxis of VTEC in patients after major orthopedic surgery to the recommended national and international guidelines. Secondary objectives: 1) to compare the frequency of prevention of VTEC with low molecular weight heparin (LMWH) to using other anticoagulants; 2) to assess patient adherence to medications recommended by the physician at discharge from the hospital. Methods: 304 patients from 11 centers after hip replacement, knee replacement or surgery in cases of hip fractures were included in this study. Demographic data, date and type of surgery, comorbidities, prescribed preventive therapy and its duration were recorded in the registration form for each patient. For statistical analysis there was used sequential method for selecting data. Results: The true picture of thromboprophylaxis in patients in hospital and after discharge was revealed. There was established that for all patients in the inpatient department for prevention of VTEC anticoagulants were prescribed. However, the duration of thromboprophylaxis in the most cases did not meet international and national guidelines. In addition, about a quarter (23.56 %) patients did not adhere to the proposed extended thromboprophylaxis. Leading position among prescribed anticoagulant take LMWH.