O'Hara Nathan N, Stein Deborah M, Haut Elliott R, Breazeale Stephen, Frey Katherine P, Slobogean Gerard P, Firoozabadi Reza, Castillo Renan, O'Toole Robert V
University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Trauma Surg Acute Care Open. 2024 Sep 3;9(1):e001511. doi: 10.1136/tsaco-2024-001511. eCollection 2024.
A recent clinical trial suggested aspirin is a viable alternative to enoxaparin for venous thromboembolism (VTE) prophylaxis in patients after orthopedic trauma. The initial impact of these findings on VTE prophylaxis prescribing is unknown. The study aimed to evaluate stated VTE prophylaxis prescribing patterns among clinicians who treat patients after orthopedic trauma.
For this clinical vignette survey, we recruited surgeons and advanced practice providers who prescribed VTE prophylaxis to patients with orthopedic trauma across 40 states. Clinicians were shown seven clinical vignettes describing hypothetical patients with orthopedic trauma based on their fracture type, treatment, VTE risk factors, additional injuries and health insurance status. We assessed the stated VTE prophylaxis medications prescribed in-hospital and at discharge, patient factors associated with changes in medication prescribing preferences and practice variation by specialty and provider training.
Among the 287 respondents, the median age was 43 years (IQR, 38-50), and 154 (weighted average, 63%) were men. For in-hospital VTE prophylaxis, enoxaparin was prescribed in 83% of the presented scenarios, and aspirin was prescribed in 13% (p<0.001). At discharge, aspirin was prescribed more frequently than enoxaparin (50% vs 41%, p<0.001). Healthcare providers with an aspirin discharge preference were 12% more likely to switch to enoxaparin if the patient had additional VTE risk factors, such as obesity (95% CI 4% to 19%, p=0.005).
Despite new clinical evidence, in-hospital VTE prophylaxis prescribing practices for patients with orthopedic trauma remain consistent with those reported a decade ago. However, compared with historical data, clinicians have significantly increased their preference for aspirin for thromboprophylaxis at discharge-unless the patient has additional thromboembolic risk factors.
5-expert opinion.
最近一项临床试验表明，对于骨科创伤患者的静脉血栓栓塞症（VTE）预防，阿司匹林是依诺肝素的可行替代药物。这些研究结果对VTE预防用药处方的初步影响尚不清楚。本研究旨在评估治疗骨科创伤患者的临床医生的VTE预防用药处方模式。
在这项临床病例调查中，我们招募了在40个州为骨科创伤患者开具VTE预防药物的外科医生和高级执业提供者。向临床医生展示了七个临床病例，这些病例描述了基于骨折类型、治疗方法、VTE危险因素、其他损伤和健康保险状况的假设骨科创伤患者。我们评估了住院期间和出院时开具的VTE预防药物、与用药处方偏好变化相关的患者因素以及按专业和提供者培训的实践差异。
在287名受访者中，中位年龄为43岁（四分位间距，38 - 50岁），154名（加权平均值，63%）为男性。对于住院期间的VTE预防，在83%的病例中开具了依诺肝素，13%的病例中开具了阿司匹林（p<0.001）。出院时，开具阿司匹林的频率高于依诺肝素（50%对41%，p<0.001）。如果患者有其他VTE危险因素，如肥胖，倾向于出院时使用阿司匹林的医疗保健提供者转而使用依诺肝素的可能性高12%（95%置信区间4%至19%，p = 0.005）。
尽管有新的临床证据，但骨科创伤患者住院期间的VTE预防用药处方实践仍与十年前报告的一致。然而，与历史数据相比，临床医生在出院时对阿司匹林进行血栓预防的偏好显著增加，除非患者有其他血栓栓塞危险因素。
5 - 专家意见
