Developing a VTE prophylaxis consensus statement for orthopedics

Dr. Javad Parvizi, FRCS, is an orthopedic surgeon and professor of orthopedic surgery at Thomas Jefferson University. He is part of a global group of experts developing an international consensus statement to standardize venous thromboembolism (VTE) prophylaxis for patients undergoing orthopedic procedures.

Patricia Chaney

Essential Insights contributor, healthcare writer

Cardinal Health provided financial support for the work of Dr. Parvizi and other experts on this consensus statement. Last year, he shared the development process for this important work with us during a webinar. Here are highlights from that talk.

Research has found that VTE incidence after orthopedic surgery can range from 22% to 60%1

Why orthopedics needs a VTE prophylaxis consensus

VTEs are an often preventable complication of surgery. Research has found that VTE incidence after orthopedic surgery can range from 22% to 60%. That leaves a lot of opportunity for prophylaxis to make an impact on patient outcomes.

“Patients do develop this complication and sometimes it can be fatal,” Dr. Parvizi said. “It is critical that us in the medical community pay attention to this issue because this issue is definitely getting attention in the legal arena.”

During the webinar, Dr. Parvizi noted that symptomatic pulmonary embolism (PE) rates haven’t changed much in recent years, despite an increase in use of anticoagulation medication. Current guidelines, which aren’t all specific to orthopedic surgery, focus primarily on chemical prophylaxis.

However, Dr. Parvizi presented a growing body of evidence showing the benefits of mechanical compression. He presented a survey of orthopedic surgeons demonstrating a shift toward using aspirin plus mechanical prophylaxis after hip and knee surgery.

Limited guidance exists for subspecialties, such as spine, rotator cuff, and anterior cruciate ligament (ACL) procedures. Dr. Parvizi and other experts felt the need to address VTE prevention and incorporate the latest research into specific guidelines for all orthopedic surgeons and specialists.

“I don’t think we can ever make VTE a non-event … but our goal is to try to reduce that as much as possible,” he said.

How the experts develop the statement

The International Consensus Meeting brought together 570 delegates from 115 countries that represent all orthopedics subspecialties, including hand and oncology. The group hopes to provide more specific protocols for all of orthopedics with this consensus.

The controlled process to develop the consensus followed 13 steps using the Delphi Process. This process guides the selection of delegates, literature review and consensus building. Following this process allows for reaching agreement in areas where the science is contradictory or there’s limited published research.

Delegates are carefully chosen based on their publication history and specialty. The delegates submit questions they would like the statement to answer. All the submissions are then consolidated into a final list of 200 questions, which are each assigned to two delegates within that subspecialty and with opposing views. The delegates research high-quality studies and formulate their answers. These answers form the basis of the consensus statement.

The delegates’ answers undergo peer review and editing. The answers are eventually extracted and merged into a final document. The document goes before a steering committee, and delegates vote on the final answers. The group is tracking the questions and answers in an app, where they also share relevant research.

“The intention of the international consensus is to develop process-based protocols we can all use to minimize this devastating complication in our patients. I think this will bring some form of harmony and standardization.”

Dr. Parvizi, FRCS, Orthopedic Surgeon and Professor of Orthopedic Surgery at Thomas Jefferson University.

The group has also developed a VTE risk calculator, which is undergoing validation and will be available in the ICM Philly mobile app. This calculator aims to look at the risk profile of each patient and recommend prophylaxis specific to that patient.

The statement has been under review for a long time. The group will have the document published in the Journal of Bone and Joint Surgery and will present the findings at the American Academy of Orthopedic Surgeons Annual Meeting in March 2022.

Dr. Javad Parvizi is a paid consultant of Cardinal Health

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