Table 4 Patient VTE risk and compliance with AOA VTE Prevention Guidelines (2018) (N = 1838).
Patient-level risk | N (%) |
|---|---|
Criteria for high PE risk | |
Major criteria (one or more): | 174 (9.5%) |
Minor criteria (three or more)†† | 96 (5.2%) |
High VTE risk (≥ 1 major criteria or ≥ 3minor criteria) | 230 (12.5%) |
Routine VTE risk (did not meet high VTE risk criteria) | 1554 (82.9%) |
High risk of bleeding*** (known bleeding disorder) | 53 (2.9%) |
Prophylaxis received^ | |
(i) Sequential compression device | 1683 (91.6) |
(ii) Aspirin- 100–300 mg per day | 836 (44.6%) |
(iii) Potent anticoagulation (LMWH, Warfarin, DOAC) | 1484 (79.1%) |
Proportion of cohort who received prophylaxis compliant with routine and high VTE risk and high bleeding risk recommendations^ | |
(1) Compliant with routine recommended care (i. & ii &/or iii.) | 1675 (91.2%) |
(2) Compliant with high VTE risk recommendations (i and iii only, did not receive aspirin unless taking preoperatively) | 1142 (62.2%) |
(3) High bleeding risk VTE prophylaxis recommendations (i. only) | 7 (0.4%) |
Patients received recommended prophylaxis for the assessed risk level (Patient risk-stratified compliant prophylaxis) | |
(1) People at routine VTE risk (N = 1554) who received routine VTE risk compliant prophylaxis | 1411 (76.8%) |
(2) High VTE risk (N = 230) who received high VTE risk compliant VTE prophylaxis | 168 (9.1%) |
(3) High bleeding risk (N = 54) who received high bleeding risk compliant VTE prophylaxis | 0 (0%) |
Elements of compliance | |
A. Received risk-stratified recommended prophylaxis (1 + 2 + 3) | 1579 (85.9%) |
Recommended duration | |
Three to six weeks (recommended) | 1035 (56.3%) |
(i) At least 21 days (considered compliant) | 1137 (61.9%) |
(ii) Ceased prophylaxis to start VTE treatment (compliant) | 42 (2.3%) |
B. Compliant with recommended duration (i. or ii)¥ | 1169 (63.6%) |
Other general recommendations | |
(i) Received neuraxial anaesthesia (N = 1837) (1179 compliant) | 1151 (62.7%) |
(ii) Neuraxial anaesthesia contraindicated (on warfarin) | 68 (3.6%) |
(iii) Bleeding mitigation (received tranexamic acid) | 1115 (59.5%) |
(iv) Ceased preoperative warfarin within 5 days of surgery‡ | 37 (2.0%) |
(v) Ceased preoperative clopidogrel within 5 days of surgery‡ | 45 (2.5%) |
(vi) Early mobilisation (walked day 0 or day 1) | 1376 (75.0%) |
C. Compliant with all relevant general recommendations (i. to vi.) | 592 (32.2%) |
Overall AOA compliance (compliant with A and B and C) | 258 (14.0%) |
