The effect of prophylaxis on the prevention of symptomatic venous thrombosis in patients with lower leg cast immobilisation or after knee arthroscopy is not clear. Our aim was to assess the current practice of thrombosis prophylaxis in Dutch hospitals and to determine considerations for prescribing prophylaxis.
Electronic questionnaires regarding thrombosis prophylaxis in patients with lower leg cast immobilisation or after knee arthroscopy were sent to all orthopaedic (90) and trauma surgery departments (89) and orthopaedic clinics (16) in the Netherlands.
Response rate was 88% for orthopaedic surgery departments/clinics and 81% for trauma surgery departments. Analysis of the questionnaires reveals that prophylaxis was not provided for patients with lower leg cast immobilisation at only 3 (4%) orthopaedic and 3 (4%) trauma surgery departments, while 10 (11%) orthopaedic surgery departments did not provide prophylaxis for patients undergoing knee arthroscopies. Substantial differences in prophylactic strategies were observed as these strategies were dependent on both the indication for treatment and on the presence of concomitant risk factors for venous thrombosis. The most reported rationales for prescribing prophylaxis were: the perceived risk reduction of prophylaxis outweighs the bleeding risk; the experience that prophylaxis is effective; to act in accordance with hospital guidelines.
Despite the lack of a solid evidence base, it seems that the large majority of patients with lower leg cast immobilisations, along with those undergoing knee arthroscopy, do receive thrombosis prophylaxis. However, depending on the indications, large variations within prophylaxis strategies seem to exist, which demonstrate the need for an evidence-based uniform prophylaxis scheme.