Implementation of a multidisciplinary, pharmacy-led, thromboprophylaxis program in total-joint arthroplasty patients

Purpose. The implementation of a multi-disciplinary, pharmacy-led, thromboprophylaxis program that reduced the rates of venous thromboembolism (VTE) in total-joint arthroplasty patients is discussed. Summary. The results from a 2005 VTE review led to the formation of a thromboprophylaxis team at Glen Cove Hospital that consisted of representatives from the departments of general surgery, orthopedic surgery, anesthesia, hematology, rehabilitative medicine, internal medicine, pharmacy, nursing, and quality management. The team created a thromboprophylaxis risk factor assessment/prescriber order sheet that reflected the American College of Chest Physicians guidelines for venous thromboprophylaxis for all patients. In 2005,87% of total-joint replacement patients received epidural anesthesia and analgesia, while the remaining 13% received spinal anesthesia and nonepidural analgesia. With both unilateral and staged bilateral surgeries, the first dose of warfarin was administered the night of surgery and continued as the sole chemical prophylaxis during epidural analgesia. For staged bilat- rin by of all eral procedures, the patient received warfarin monotherapy for five days after the first dose and was then discontinued. Once the second procedure was completed, warfarin was restarted the night of surgery and continued until six hours after the epidural catheter was removed. As recommended by the team, the practice of warfarin monotherapy was stopped after the first dose. By reducing warfarin monotherapy for thromboprophylaxis in total-joint replacement surgery, the team reduced rates of VTE by 60%. Conclusion. The formation of a thromboprophylaxis team led to the development and implementation of a thromboprophylaxis prescriber order sheet. A 48% reduction in overall VTE rates and a 60% reduction in pulmonary embolism rates were observed in patients undergoing total-joint replacement procedures.