van Adrichem R A, van Oosten J P, Cannegieter S C, Schipper I B, Nelissen R G H H
Departments of Clinical Epidemiology, Orthopaedic Surgery, Thrombosis and Haemostasis, Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands, *corresponding author: tel.: +31(0)71-5263606, email:
Neth J Med. 2015 Jan;73(1):23-9.
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.
预防性治疗对小腿石膏固定患者或膝关节镜检查后预防有症状静脉血栓形成的效果尚不清楚。我们的目的是评估荷兰医院目前对血栓形成的预防措施，并确定开具预防性治疗的考虑因素。
向荷兰所有骨科（90个）、创伤外科（89个）和骨科诊所（16个）发送了关于小腿石膏固定患者或膝关节镜检查后血栓形成预防的电子问卷。
骨科手术科室/诊所的回复率为88%，创伤外科科室的回复率为81%。对问卷的分析显示，只有3个（4%）骨科和3个（4%）创伤外科科室未对小腿石膏固定患者进行预防性治疗，而10个（11%）骨科手术科室未对膝关节镜检查患者进行预防性治疗。观察到预防性策略存在显著差异，因为这些策略既取决于治疗指征，也取决于静脉血栓形成的伴随风险因素的存在。报告最多的开具预防性治疗的理由是：认为预防性治疗降低风险的作用大于出血风险；认为预防性治疗有效；按照医院指南行事。
尽管缺乏确凿的证据基础，但似乎绝大多数小腿石膏固定患者以及膝关节镜检查患者确实接受了血栓形成预防性治疗。然而，根据指征不同，预防性策略似乎存在很大差异，这表明需要一个基于证据的统一预防性方案。
