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Venous Thromboembolism Prophylaxis – The Other Side of the Coin: A Review of Literature
Abstract
Background: There are no local guidelines for prophylaxis against Venous Thrombo-Embolism (VTE).
In the absence of any guidelines, most of the information available has been provided mainly by the
pharmaceutical industry which is an interested party. There have been publications in local journals that
lean more on endorsing guidelines developed elsewhere. Unfortunately, such guidelines have not been
embraced by everyone even in their countries of origin yet they are sometimes presented as the universally accepted standard of care.
Objective: We sought to elucidate some of the reasons for the opposition to these guidelines in this article. Our aim is not to convince readers to change their practice but to provide information that may be useful to them as they make decisions on this matter. We also hope to stimulate debate on this issue and hopefully contribute to the development of a national guideline for and by the orthopaedic community.
Data source: Publications from peer reviewed journals.
Results: The assumed relationship between deep vein thrombosis and pulmonary embolism is erroneous.
The “post-phlebitic limb” is not always post-phlebitic. Large studies comparing the morbidity and mortality prior to and after introduction of various VTE prophylaxis guidelines find that the measures proposed by various guidelines are not efficacious. Most early deaths occurring after orthopaedic procedures are not a result of pulmonary embolism. There exists a serious conflict of interest in many of the studies that support chemo-prophylaxis for VTE prevention. The risks from chemoprophylaxis for VTE are greater than the anticipated benefit.
Conclusions: Evidence adduced in this article casts doubts on the rationale and efficacy of VTE chemoprophylaxis recommendations by various international guidelines and does not support their whole-scale adoption.
Recommendations: Kenya Orthopaedic Association needs to put in place mechanisms to develop local
guidelines based on the local data and spearheaded by the orthopaedic fraternity.
In the absence of any guidelines, most of the information available has been provided mainly by the
pharmaceutical industry which is an interested party. There have been publications in local journals that
lean more on endorsing guidelines developed elsewhere. Unfortunately, such guidelines have not been
embraced by everyone even in their countries of origin yet they are sometimes presented as the universally accepted standard of care.
Objective: We sought to elucidate some of the reasons for the opposition to these guidelines in this article. Our aim is not to convince readers to change their practice but to provide information that may be useful to them as they make decisions on this matter. We also hope to stimulate debate on this issue and hopefully contribute to the development of a national guideline for and by the orthopaedic community.
Data source: Publications from peer reviewed journals.
Results: The assumed relationship between deep vein thrombosis and pulmonary embolism is erroneous.
The “post-phlebitic limb” is not always post-phlebitic. Large studies comparing the morbidity and mortality prior to and after introduction of various VTE prophylaxis guidelines find that the measures proposed by various guidelines are not efficacious. Most early deaths occurring after orthopaedic procedures are not a result of pulmonary embolism. There exists a serious conflict of interest in many of the studies that support chemo-prophylaxis for VTE prevention. The risks from chemoprophylaxis for VTE are greater than the anticipated benefit.
Conclusions: Evidence adduced in this article casts doubts on the rationale and efficacy of VTE chemoprophylaxis recommendations by various international guidelines and does not support their whole-scale adoption.
Recommendations: Kenya Orthopaedic Association needs to put in place mechanisms to develop local
guidelines based on the local data and spearheaded by the orthopaedic fraternity.
