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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 2, 127-132.
doi: 10.1302/0301-620X.90B2.20106  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Orthopaedic thromboprophylaxis

LIMITATIONS OF CURRENT GUIDELINES

D. Warwick, MD, FRCS (Orth), Consultant Orthopaedic Surgeon, Honorary Senior Lecturer1; O. E. Dahl, MD, PhD, General Orthopaedic Surgeon, Professor, Executive Director2; and W. D. Fisher, MD, FRCS(Ed), Orthopaedic Surgeon and Assistant Professor3

1 University of Southampton, Southampton University Hospitals, Southampton, SO16 6UY, UK.
2 Thrombosis Research Institute, 1 Manresa Road, Chelsea, London, SW3 6LR, UK.
3 McGill University Health Centre, 1650 Cedar Avenue, Montréal, Quebec, HG3 1A4, Canada.

Correspondence should be sent to Mr D. Warwick; e-mail: djwarwick{at}compuserve.com

Thromboprophylaxis remains a controversial subject. A vast amount of epidemiological and trial data about venous thromboembolism has been published over the past 40 years. These data have been distilled and synthesised into guidelines designed to help the practitioner translate this extensive research into ‘evidence-based’ advice.

Guidelines should, in theory, benefit patient care by ensuring that every patient routinely receives the best prophylaxis; without guidelines, it is argued, patients may fail to receive treatment or be exposed to protocols which are ineffective, dangerous or expensive.

Guidelines, however, have not been welcomed or applied universally. In the United States, orthopaedic surgeons have published their concerns about the thromboprophylaxis guidelines prepared by the American College of Chest Physicians. In Britain, controversy persists with many surgeons unconvinced of the risk/benefit, cost/benefit or practicality of thromboprophylaxis. The extended remit of the recent National Institute of Clinical Excellence thromboprophylaxis guidelines has been challenged.

The reasons for this disquiet are addressed in this paper and particular emphasis is placed on how clinically-acceptable guidelines could be developed and applied.




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Orthopaedic thromboprophylaxis
K C Kong
J Bone Joint Surg Br Online, 21 Feb 2008 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General