DVT/VTE Prevention

To reduce the complication rate of deep vein thrombosis and venous thromboembolism in total hip and total knee replacement patients, North Kansas City Hospital’s orthopedists and hospitalists recently collaborated to research best practices and review guidelines from the Chest Pain Society and the American Academy of Orthopaedic Surgeons. Their work resulted in the implementation of an updated VTE/DVT and prophylaxis order set for orthopedic patients.

Lancer Gates, DO

Lancer G. Gates, DO

Previously, orthopedists and hospitalists each worked under different protocols which limited coordination. The revised order sets now include risk assessments with sub-categories indicating low or high risk, and discharge medications. The DVT/VTE prevention initiative is one of five complications being addressed by the NKCH orthopedic physicians. In this patient population at a higher risk for bleeding, coordinating care across disciplines helps strike the appropriate balance of anticoagulation medication.

“In an effort of continuous improvement, we’ve come together and created evidence-based guidelines to further reduce DVT for total knee and total hip arthroplasty patients,” said Lancer G. Gates, DO, a hospitalist with Gates Hospitalists at NKCH. Collaborating physician Steven B. Smith, MD, an orthopedist with Northland Bone & Joint, added “As a high-volume orthopedic center, we have a lot of opportunity to collaborate with hospitalists to maximixe outcomes and patients satisfaction. We work closely together to share data and determine the safest systems for our patients.”

Steven Smith, MD

Steven B. Smith, MD

The updated protocol resulted from clinical evidence supporting that aspirin alone is not recommended for high risk patients with one or more of the following conditions:

  • History of DVT with negative pre-operative ultrasound examination
  • Active cancer
  • Hypercoagulable states
  • Two of three comorbidities: heart disease, lung disease, diabetes
  • Morbid obesity
  • Personal or family history of DVT or pulmonary embolism
  • Immobility

Treatments may include:

High Risk

  • Pharmacologic prophylaxis – excluding aspirin alone
  • Antiembolitic stockings
  • SCD hose
  • Foot pump

Low Risk

  • Antiembolitic stockings
  • SCD hose
  • Foot pump
  • Pharmacologic prophylaxis, as needed
  • Aspirin

As NKCH practices continuous improvement, the Orthopedic Quality team and Complication Subgroup team will educate clinical staff on the new orthopedic protocols. It will also monitor compliance to protocols and patients’ postoperative conditions.