An Orthopod’s Perspective Adrian Beaumont Consultant Orthopaedic Surgeon Salisbury District...
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Transcript of An Orthopod’s Perspective Adrian Beaumont Consultant Orthopaedic Surgeon Salisbury District...
An Orthopod’s PerspectiveAn Orthopod’s Perspective
Adrian BeaumontConsultant Orthopaedic SurgeonSalisbury District Hospital
Size of Problem
? 25,000 deaths per year VTE in 40% to 60% joint replacements Fatal PE in 0.1% to 5%
Inconsistent thromboprophylaxis Joint registry shows increasing use of
mechanical and chemical methods
Hugh Owen Thomas 1834 - 1891
Fast Track Mobilisation
No clear data on VTE risk Intuitively beneficial
Rudolf Virchov 1821 - 1902
Nice Guidelines 2010 Had orthopaedic input Risk assess Hip and knee replacements high risk Combined methods Oral agents (not aspirin) Duration ‘Opt out’ when bleeding risk
Evidence! Or Evidence?Cross trial comparisons
Criteria End points Definitions Sponsored? Statistics
Need Expert Interpretation
Anti-Embolism Stockings
Often problematic for our patients
Wounds, swelling etc Restricted movement Large legs
Hip Fractures
Very common High mortality Immobility Delay to theatre Age
Lower Limb Casts Evidence if risk ? UK lags behind Europe Risk assess or risk forgetting
Plymouth type scoring system LMWH prescribed at discretion Ongoing audit
Major Bleeding (EMEA)
Fatal Bleeding Decrease Hb by 20 grams Transfusion 2 units blood Critical bleeding Leading to discontinuation At surgical site Leading to reoperation
Deep Infection
Often disastrous
Usually means implant removal
Summary
The importance VTE recognised We have some knowledge of efficacy Variable but increasing prophylaxis
The adverse effects must be considered Expert guidance needed There will be ongoing change
Thank You