Rodgers A, Gray H, MacMahon S
Department of Medicine, University of Auckland, New Zealand.
Aust N Z J Surg. 1994 Mar;64(3):167-72. doi: 10.1111/j.1445-2197.1994.tb02170.x.
A survey was conducted of the attitudes and practices of New Zealand orthopaedic surgeons on the use of pharmacological thromboprophylaxis (PT) for patients undergoing major hip or knee surgery. A questionnaire was sent to all 106 consultant surgeons known to perform hip or knee surgery and a response rate of 89% was obtained. The results suggested that while almost all surgeons used PT at some time, only about one-third of elective surgery patients and just a few per cent of patients with neck of femur fracture (NOFF) receive PT. For about three-quarters of surgeons, heparin (usually low molecular weight) was the most frequently used PT. About half of the surgeons began prophylaxis pre-operatively and about half stopped it when the patients were mobile postoperatively. Previous venous thromboembolism was felt by almost all surgeons to be a very important indication for PT; gross obesity, prolonged pre-operative immobility and active malignancy were thought to be very important factors by approximately one-half of the surgeons. The presence of a major bleeding diathesis or active peptic ulcer was cited as a contraindication to PT by more than two-thirds of all surgeons. Fear of bleeding complications and the rarity of thromboembolic complications were cited as reasons for limited use of PT by about one-third of surgeons. The results suggest that most surgeons usually rely on non-pharmacological methods of thromboprophylaxis, particularly for NOFF patients.(ABSTRACT TRUNCATED AT 250 WORDS)
针对新西兰骨科医生对接受髋关节或膝关节大手术患者使用药物性血栓预防（PT）的态度和做法开展了一项调查。向所有已知进行髋关节或膝关节手术的106名顾问外科医生发送了问卷，回收率为89%。结果表明，虽然几乎所有外科医生在某些时候都会使用PT，但只有约三分之一的择期手术患者以及仅百分之几的股骨颈骨折（NOFF）患者接受PT。对于约四分之三的外科医生来说，肝素（通常是低分子量肝素）是最常用的PT。约一半的外科医生在术前开始预防，约一半在患者术后能够活动时停止预防。几乎所有外科医生都认为既往静脉血栓栓塞是PT的一个非常重要的指征；约一半的外科医生认为严重肥胖、术前长期制动和活动性恶性肿瘤是非常重要的因素。超过三分之二的外科医生将存在严重出血素质或活动性消化性溃疡列为PT的禁忌证。约三分之一的外科医生将担心出血并发症以及血栓栓塞并发症罕见作为PT使用受限的原因。结果表明，大多数外科医生通常依赖非药物性血栓预防方法，尤其是对于NOFF患者。（摘要截取自250字）
