Physicians' perceptions of the definition of major bleeding in major orthopedic surgery: results of an international survey.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
  • Author(s): Ginzburg E;Ginzburg E; Dujardin F
  • Source:
    Journal of thrombosis and thrombolysis [J Thromb Thrombolysis] 2011 Feb; Vol. 31 (2), pp. 188-95.
  • Publication Type:
    Journal Article; Research Support, Non-U.S. Gov't
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Kluwer Academic Publishers Country of Publication: Netherlands NLM ID: 9502018 Publication Model: Print Cited Medium: Internet ISSN: 1573-742X (Electronic) Linking ISSN: 09295305 NLM ISO Abbreviation: J Thromb Thrombolysis Subsets: MEDLINE
    • Publication Information:
      Original Publication: [Dordrecht ; Norwell, MA] : Kluwer Academic Publishers, c1994-
    • Subject Terms:
    • Abstract:
      Decisions regarding choice of thromboprophylaxis in patients undergoing major orthopedic surgery are based on assessment of individual patient risk for thrombosis versus risk for bleeding. An international survey sought physician views on definitions and relative importance of different types of major bleeding. A random sample of physicians from five countries (100 physicians per country, mainly surgeons) completed an internet-based 13-question survey on perceptions, concerns, and relevance of bleeding associated with thromboprophylaxis in major orthopedic surgery. Over 80% of responders were concerned or very concerned about bleeding with >70% considering surgical-site bleeding as the most concerning, and relevant type and site for bleeding. Nearly 80% of responders considered surgical-site bleeding to increase patient length of hospital stay, and >70% noted that it complicates patient rehabilitation. After fatal bleeding, bleeding leading to re-operation was ranked as the most concerning type of major bleed. Less than half of responders reported closely reading the major-bleeding definitions in clinical study publications. Most responders favored anticoagulants that could offer a reduced bleeding risk and similar venous thromboembolism (VTE) prevention compared to current anticoagulants rather than a decrease in VTE and similar bleeding risk. There is a disconnect between the definitions of major bleeding that surgeons would apply to describe bleeding associated with VTE thromboprophylaxis, and those used in clinical studies reporting the safety profiles of newer anticoagulant agents. Misperceptions about the benefit-to-harm profiles of thromboprophylactic therapies may incorrectly inform treatment choices in patients at high risk for post-operative VTE.
    • References:
      Eur J Med Res. 2004 Mar 30;9(3):150-70. (PMID: 15096326)
      N Engl J Med. 2008 Jun 26;358(26):2776-86. (PMID: 18579812)
      Lancet. 2007 Sep 15;370(9591):949-56. (PMID: 17869635)
      N Engl J Med. 2009 Apr 2;360(14):1378-80. (PMID: 19339718)
      J Thromb Haemost. 2010 Jan;8(1):202-4. (PMID: 19878532)
      Br J Clin Pharmacol. 2006 Aug;62(2):232-6. (PMID: 16842399)
      Thromb Res. 2006;117(5):569-77. (PMID: 15913715)
      Curr Med Res Opin. 2005 Jul;21(7):1085-90. (PMID: 16004677)
      N Engl J Med. 2008 Jun 26;358(26):2765-75. (PMID: 18579811)
      Lancet. 2009 May 16;373(9676):1673-80. (PMID: 19411100)
      Health Qual Life Outcomes. 2009 Apr 07;7:30. (PMID: 19348685)
      Lancet. 2008 Jul 5;372(9632):31-9. (PMID: 18582928)
      J Thromb Haemost. 2007 Nov;5(11):2178-85. (PMID: 17764540)
      Arch Intern Med. 2009 Oct 26;169(19):1756-61. (PMID: 19858432)
      N Engl J Med. 2009 Aug 6;361(6):594-604. (PMID: 19657123)
      Chest. 2008 Jun;133(6 Suppl):257S-298S. (PMID: 18574268)
      Arch Intern Med. 2009 Oct 26;169(19):1737-9. (PMID: 19858427)
      Clin Appl Thromb Hemost. 2009 Jul-Aug;15(4):377-88. (PMID: 19608549)
      J Arthroplasty. 2009 Jan;24(1):1-9. (PMID: 18534438)
      Chest. 2008 Jun;133(6 Suppl):381S-453S. (PMID: 18574271)
    • Publication Date:
      Date Created: 20100720 Date Completed: 20110425 Latest Revision: 20211020
    • Publication Date:
      20231215
    • Accession Number:
      10.1007/s11239-010-0498-9
    • Accession Number:
      20640486