Current Trends Regarding Perioperative Pharmacological Anticoagulation in Lower Limb Surgeries among Orthopedic Surgeons of Pakistan- A Critical Survey

Authors

Sheikh Muhammad Ebad Ali Department of Orthopedic and Surgery, Dow University of Health Sciences, Karachi, Pakistan.
Badaruddin Sahito Department of Orthopedic and Surgery, Dow University of Health Sciences, Karachi, Pakistan.
Syeda Iqra Qadri Department of UGME, Dow University of Health Sciences, Karachi, Pakistan.
Hira Iqbal Naviwala Department of UGME, Dow University of Health Sciences, Karachi, Pakistan.
Hina Khan Department of UGME, Karachi Medical and Dental College, Karachi, Pakistan.
Omer Awan Department of Emergency, Jinnah Postgraduate Medical Center, Karachi, Pakistan.
Muhammad Mohsin Mushtaq Department of Emergency, Dow University of Health Sciences, Karachi, Pakistan.

Anticoagulation, Orthopedic surgery, Preventive medicine, Thromboembolism, Lower limb, Pulmonary embolism

Abstract: Perioperative anticoagulation has been recommended by AAOS, AACP, and ASH during orthopedic procedures of the lower limb.

Guidelines show a difference of opinion regarding the optimum duration and drug of choice giving a way to use different methods of

anticoagulation. This survey assessed the differences in preferences for pharmacological anticoagulation in lower limb surgeries among

orthopedic surgeons of Pakistan.

Materials & Methods: Orthopedic surgeons (n=632) were invited to fill in the questionnaires. A total of 85 orthopedic surgeons responded

completely. An electronic eight-question survey was designed which included questions about demographics of surgeons, the drug of choice,

perioperative duration, preferred surgeries, and average incidence of thromboembolism per year.

Results: 12.9% surgeons use anticoagulation for all surgeries while 82.3% of orthopedic surgeons use anticoagulants in selective surgeries.

LMWH (94.1%) and Rivaroxaban (17.6%) were the drug of choice for most surgeons. 70.6% of respondents never used anticoagulation

preoperatively. 17.7% used it three days preoperatively. 28.24% of surgeons prescribed anticoagulation for 3 days postoperatively while 17.7%

of surgeons prescribed anticoagulation for 2 weeks postoperatively. 10.6% of surgeons never used anticoagulation postoperatively.

Arthroplasty (71.7%), trauma (55.3%), and pelvis and acetabulum (54.1%) were the subspecialties with routine anticoagulation. 81.2% and

17.7% of surgeons reported less than 1% and 1% to 3% incidence of thromboembolism, respectively. No surgeon reported any incidence of

thromboembolism above 5%.

Conclusion: Use of anticoagulation is prevalent among orthopedic surgeons in Pakistan. However, significant differences are observed

regarding the perioperative duration. The surgeons need to prescribe DOAC such as Rivaroxaban and Dabigatran as agents of choice while

extended postoperative pharmacological anticoagulation of 28-35 days needs to be adopted.