The Use of Warfarin as Thromboprophylaxis for Lower Limb Arthroplasty
| Autor: | Piyush K Upadhyay, Mark Robert Dunbar, Shanmugam Karthikeyan |
|---|---|
| Rok vydání: | 2008 |
| Předmět: |
medicine.medical_specialty
Arthroplasty Replacement Hip medicine.medical_treatment Orthopaedics Lower limb Postoperative Complications Clinical Protocols Thromboembolism Humans Medicine Dosing Arthroplasty Replacement Knee Delayed discharge business.industry Warfarin prophylaxis Warfarin Anticoagulants General Medicine Length of Stay Postoperative rehabilitation Arthroplasty Surgery Anesthesia Costs and Cost Analysis business Hospital stay medicine.drug |
| Zdroj: | The Annals of The Royal College of Surgeons of England. 90:500-503 |
| ISSN: | 1478-7083 0035-8843 |
| Popis: | INTRODUCTION Most orthopaedic surgeons in the UK use some form of prophylaxis against venous thromboembolic events. Warfarin has been recommended as one of the preferred methods to use. The period of in-hospital postoperative rehabilitation has reduced significantly since lower limb arthroplasty was introduced. We sought to identify and quantify any delay in discharge associated in using warfarin as chemical prophylaxis. PATIENTS AND METHODS During a 12-week period, all patients undergoing a lower limb arthroplasty procedure were identified and any delay in discharge related to their warfarin prophylaxis was recorded. RESULTS Of the 25 arthroplasties performed in this time period, 17 (68%) were subject to a delay. The total delay in discharge was 39 days. When the standard warfarin dosing protocol was followed, 33% of patients were still delayed. When the protocol was not followed, only 23% were delayed. The majority of deviations from the protocol led to a shorter hospital stay. DISCUSSION Patients using warfarin prophylaxis generate an additional cost of £417 related to bed occupancy. There is considerable scope for significantly reducing this cost by moving the early postoperative anticoagulation monitoring into the community. Delayed discharge is an important consideration in the economic issues that surround the choice of thromboprophylaxis. |
| Databáze: | OpenAIRE |
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