Comparing Australian orthopaedic surgeons' reported use of thromboprophylaxis following arthroplasty in 2012 and 2017

Background: It is generally accepted that all arthroplasty patients should receive venous thromboembolism (VTE)and bleeding risk assessments, and that postoperative thromboprophylaxis be routinely prescribed where appropriate.Guideline recommendations regarding what to prescribe, however, have been inconsistent over the years, particularlyregarding the appropriateness of aspirin. Our aim was to explore thromboprophylaxis patterns in use following hip andknee arthroplasty in Australia, and to examine associated variables.Methods: Orthopaedic surgeons were invited via mail to participate in two national surveys, conducted in 2012 (N =478) and 2017 (N = 820), respectively.Results: The final response rates were 50.0 and 65.8% for 2012 and 2017, respectively. The thromboprophylaxisprescribing routines reported by respondents were divided into four categories: anticoagulant-only (thesame anticoagulant-only routine for everyone), aspirin-only (aspirin for everyone), staged-supply (ananticoagulant during the initial postoperative period, followed by aspirin, for everyone) and risk-stratificationroutines (differing regimens depending on patients’ perceived risk of VTE). The most common approachesreported were anticoagulant-only routines; however, their popularity almost halved within the five-yearperiod (from ~ 74% to ~ 41%). Conversely, staged-supply and risk-stratification protocol usage increased bymore than two and nine times, respectively. In 2017, over one-half of surgeons reported prescribing aspirin intheir practice. Reported concern for postoperative VTE and infections (OR 0.555 95% CI 0.396–0.779, p = 0.001and OR 1.455 95% CI 1.010–2.097, p = 0.044 respectively), as well as Arthroplasty Society membership (OR 2.81495% CI 1.367–5.790, p = 0.005) were predictors for use of aspirin (Cox and Snell R square = 0.072). The factormost commonly reported to shape surgeons’ protocols was research literature. Factors limiting prescribing ofpharmacological prophylaxis included a perception that it increases bleeding and wound infection risk, isinconvenient, and lacks evidence applicable to real-world practice.Conclusions: prevention post-arthroplasty is an evolving and multi-faceted entity, influenced by a range offactors and seemingly in need of robust evidence from large clinical trials to guide practice. The datahighlighted potential short-falls in practice related to aspirin over-use, which could be further explored andaddressed in future studies in order to optimise patient outcomes and reduce the significant morbidity andhealthcare costs associated with VTE following these increasingly common surgical procedures