prikaz prve stranice dokumenta Warfarin should not be used for thromboprohylaxis in elective major orthopaedic surgery: a Croatian perspective
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Scientific paper - Original scientific paper
Warfarin should not be used for thromboprohylaxis in elective major orthopaedic surgery: a Croatian perspective
Medicinski glasnik, 14 (2017), 2; 244-249. https://doi.org/10.17392/902-17
Kolundžić, Robert; Šimić Jovičić, Marijana; Đinkić, Maja; Petrović, Tadija; Crnković, Tomislav; Trkulja, Vladimir

Institutional repository: Dr Med - University of Zagreb School of Medicine Digital Repository

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Kolundžić, R., Šimić Jovičić, M., Đinkić, M., Petrović, T., Crnković, T. & Trkulja, V. (2017). Warfarin should not be used for thromboprohylaxis in elective major orthopaedic surgery: a Croatian perspective. Medicinski glasnik, 14. (2), 244-249. doi: 10.17392/902-17

Kolundžić, Robert, et al. "Warfarin should not be used for thromboprohylaxis in elective major orthopaedic surgery: a Croatian perspective." Medicinski glasnik, vol. 14, no. 2, 2017, pp. 244-249. https://doi.org/10.17392/902-17

Kolundžić, Robert, Marijana Šimić Jovičić, Maja Đinkić, Tadija Petrović, Tomislav Crnković and Vladimir Trkulja. "Warfarin should not be used for thromboprohylaxis in elective major orthopaedic surgery: a Croatian perspective." Medicinski glasnik 14, no. 2 (2017): 244-249. https://doi.org/10.17392/902-17

Kolundžić, R., et al. (2017) 'Warfarin should not be used for thromboprohylaxis in elective major orthopaedic surgery: a Croatian perspective', Medicinski glasnik, 14(2), pp. 244-249. doi: 10.17392/902-17

Kolundžić R, Šimić Jovičić M, Đinkić M, Petrović T, Crnković T, Trkulja V. Warfarin should not be used for thromboprohylaxis in elective major orthopaedic surgery: a Croatian perspective. Medicinski glasnik [Internet]. 2017 August 01 [cited 2024 May 03];14(2):244-249. doi: 10.17392/902-17

R. Kolundžić, M. Šimić Jovičić, M. Đinkić, T. Petrović, T. Crnković and V. Trkulja, "Warfarin should not be used for thromboprohylaxis in elective major orthopaedic surgery: a Croatian perspective", Medicinski glasnik, vol. 14, no. 2, pp. 244-249, August 2017. [Online]. Available at: https://urn.nsk.hr/urn:nbn:hr:105:185257. [Accessed: 03 May 2024]

Metadata
Title (english)Warfarin should not be used for thromboprohylaxis in elective major orthopaedic surgery: a Croatian perspective
AuthorRobert Kolundžić
AuthorMarijana Šimić Jovičić
AuthorMaja Đinkić
AuthorTadija Petrović
AuthorTomislav Crnković
AuthorVladimir Trkulja
Author's institutionUniversity of Zagreb
School of Medicine
Scientific / art field,
discipline and subdiscipline		BIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Abstract (english)
Aim: To identify modes of venous thromboembolism (VTE) prophylaxis in patients undergoing elective major orthopaedic surgery (total hip or knee arthroplasty, THA/TKA) at a single university-associated hospital in Croatia. ----- Methods: A retrospective analysis of consecutive patients subjected to THA or TKA over a two-year period (2014-2015) with a focus on anticoagulation during the first 15 post-surgical days (period of highest VTE risk). ----- Results: Of 603 identified patients three (0.5%) were not anticoagulated (haemophilia) and others received perioperative doses of low molecular weight heparins (LMWH). Overall, 228 (37.8%) patients received prophylaxis not involving warfarin, and 372 continued with short-term LMWH with switching to warfarin. They contributed a total of 1218 international normalized ratio (INR) values (median=3, range=1-8). These were consistently below the target INR range across the observed period. Between post-surgical days 6 and 15 (after the initial titration), 438 values were taken in patients treated with LMWH+warfarin and 92.7% were below, and only 6.8% within the target range; 580 values were taken in patients already switched to warfarin, 74% were below and only 25% within the range. ----- Conclusion: The prevailing mode of VTE prophylaxis was in a clear contrast to (then) actual professional guidelines, with inadequate monitoring and poor anticoagulation. There is no reason to expect a substantially different situation at other institutions across the country. The prevailing practice of VTE prophylaxis in major orthopaedic surgery in Croatia should be promptly abandoned and up-dated in agreement with the current state of the art.
Abstract (croatian)
Cilj: Identificirati modalitete prevencije venskog tromboembolizma (VTE) u bolesnika podvrgnutih elektivnim velikim ortopedskim zahvatima (totalna artroplastika kuka ili koljena) u jednom sveučilišnom medicinskom centru u Hrvatskoj. ----- Metode: Retrospektivna analiza podataka o uzastopnim bolesnicima, podvrgnutim totalnoj artroplastici kuka ili koljena, tijekom dvije godine (2014-2015), s fokusom na antikoagulacijsko liječenje tijekom prvih 15 postoperativnih dana (razdoblje najvišeg rizika za VTE). ----- Rezultati: Od ukupno 603 bolesnika, troje (0.5%) nisu bili antikoagulirani (hemofilija), dok su ostali primili preoperativne doze niskomolekularnog heparina (LMWH). U ukupno 228 (37.8%) bolesnika antikoagulacijski tretman nije uključivao varfarin, dok su 372 bolesnika tretirana kratkotrajnom primjenom LMWH-a s prijelazom na varfarin. Tijekom promatranog razdoblja ukupno je izmjereno 1.218 vrijednosti internacionalnog normaliziranog omjera (INR) (medijan=3, raspon= 1-8, po bolesniku). Vrijednosti su konzistentno bile ispod terapijskog INR-raspona. U razdoblju između šestog i petnaestog postoperativnog dana (nakon početne titracije), ukupno je izmjereno 438 INR-vrijednosti u bolesnika koji su primali i LMWH i varfarin, te je 92.7% njih bilo ispod terapijskog raspona, a samo 6.8% vrijednosti bilo je u terapijskom rasponu. Istodobno, izmjereno je ukupno 580 INR-vrijednosti u bolesnika koji su već bili prebačeni na varfarin – 74% vrijednosti bilo je ispod, a samo 25% vrijednosti bilo je u terapijskom rasponu. ----- Zaključak: Opaženi dominantni oblik VTE profilakse u izravnoj je suprotnosti s profesionalnim smjernicama, s neadekvatnim nadzorom i nedostatnom antikoagulacijom. Nema razloga očekivati da je stanje bitno drugačije u ostalim institucijama u zemlji. Taj predominantni oblik VTE profilakse u velikim ortopedskim zahvatima u Hrvatskoj treba što prije napustiti i uvesti postupke u skladu s trenutno važećim standardima dobre kliničke prakse.
Languageenglish
Publication typeScientific paper - Original scientific paper
Publication statusPublished
Peer reviewPeer review
Publication versionPublished version
Journal titleMedicinski glasnik
Numberingvol. 14, no. 2, pp. 244-249
p-ISSN1840-0132
DOIhttps://doi.org/10.17392/902-17
URN:NBNurn:nbn:hr:105:185257
Publication2017-08-01
Document URLhttps://doi.org/10.17392/902-17
Type of resourceText
Access conditionsOpen access
Terms of useLicence In copyright icon
Created on2024-03-28 09:16:48