American College of Foot and Ankle Surgeons' Clinical Consensus Statement: Risk, Prevention, and Diagnosis of Venous Thromboembolism Disease in Foot and Ankle Surgery and Injuries Requiring Immobilization

Fleischer, Adam E.; Abicht, Bradley P.; Baker, Jeffrey R.; Boffeli, Troy J.; Jupiter, Daniel C.; Schade, Valerie L.

doi:10.1053/j.jfas.2015.02.022

Cited by 47 publications

(57 citation statements)

References 92 publications

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“…[7][8][9][10] The decision whether or not to use thrombosis chemoprophylaxis is therefore decided by weighing up the patient's risk for bleeding against the risk of developing VTE. No universal guidelines are available, although the general consensus from various bodies [31,34,38,40] and published articles [6,12,13,21,22,24,25,27,30,33,39] is that use of prophylactic anticoagulation is not advocated in foot and ankle surgery In a previous prospective study, [37] we found that the absolute number of cases of VTE after foot and ankle surgery was unacceptably high (11/130 (8.5%)), although this was not statistically significant owing to the relatively small number of cases. We identified a cohort of patients who were particularly prone to developing VTE after foot and ankle surgery.…”

Section: Discussionmentioning

confidence: 97%

“…Although the majority of recent studies do not advocate the routine use of chemoprophylaxis in foot and ankle surgery, [6,12,13,21,22,25,27,30,33,[38][39][40] several authors recommend its use in patients with identifiable specific clinical risk factors. [6,[8][9][10][11][12][13][14][15][16][17][18][19][20]26,37,41] A difficulty of long-term follow-up of patients is that many DVT events occur several weeks or longer after discharge.…”

Section: Researchmentioning

confidence: 99%

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The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

et al. 2017

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Section: Discussionmentioning

confidence: 97%

Section: Researchmentioning

confidence: 99%

The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

et al. 2017

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“…La estasis venosa y la lesión vascular son posibles luego de una cirugía de tobillo y pie, especialmente si se utiliza inmovilización asociada a descarga. Los estados de hipercoagulabilidad pueden ser hereditarios o adquiridos, 8,9 y los más importantes son: el factor V Leiden (causa resistencia a la actividad antitrombótica de la proteína C), el síndrome de anticuerpos anticardiolipídicos, el lupus, la hiperhomocisteinemia, la deficiencia del anticoagulante endovenoso de la proteína C, proteína S y factor antitrombótico III. 1,10 Otros factores de riesgo que se han asociado a la prevalencia de trombosis son: edad >50 años, sepsis, internación prolongada, viajes aéreos, insuficiencia cardíaca congestiva o insuficiencia respiratoria, síndrome nefrótico, obesidad, terreno varicoso, anticonceptivos orales, tratamiento con estrógenos, lesión de la médula espinal, antecedente de accidente cerebrovascular, enfermedad inflamatoria del intestino, tabaquismo, embarazo, antecedente de catéter venoso femoral, diabetes, hipertensión arterial e hiperlipidemia.…”

Section: Factores De Riesgounclassified

“…8 La colocación de un manguito hemostático por más de 90 minutos, la inmovilización posoperatoria y la falta de carga son factores de riesgo en las cirugías de tobillo y pie. 9,[15][16][17][18]…”

Section: Factores De Riesgounclassified

“…5,6 Pese a esta información, la tromboprofilaxis en cirugías de tobillo y pie no se encuentra estandarizada, debido a que el riesgo de tromboembolismo venoso, según la bibliografía consultada, es bajo. [7][8][9] El propósito de este estudio es aportar un algoritmo para la prevención de la trombosis venosa profunda (TVP) en las cirugías de tobillo y pie, sobre la base de nuestra experiencia, además de una revisión bibliográfica internacional.…”

Section: Introductionunclassified

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Trombosis venosa profunda en cirugías de tobillo y pie. Algoritmo de profilaxis [A prophylaxis algorithm for deep vein thrombosis in ankle and foot surgery]

Masaragian¹,

Perin²,

Coria³

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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Introducción: La enfermedad tromboembólica es una de las complicaciones serias en la cirugía ortopédica. La tromboprofilaxis para las cirugías de tobillo y pie no está estandarizada, porque la incidencia es baja, según la bibliografía. El objetivo de este estudio es aportar un algoritmo de prevención para la trombosis venosa profunda y una revisión de la bibliografía.Materiales y Métodos: Se llevó a cabo una revisión de las historias clínicas de los pacientes operados entre 2011 y 2017. La muestra estaba integrada por 696 hombres (28,98%) y 1706 mujeres (71,02%), con un promedio de edad de 51 años (rango 20-82). Se realizaron 2402 procedimientos, 575 (23,94%) fueron por patologías traumáticas y 1827 (76,06%), por patologías ortopédicas.Resultados: Nueve pacientes (0,37%) presentaron trombosis venosa profunda y solo dos, tromboembolismo pulmonar (0,08%). Los procedimientos en los que ocurrieron fueron: artroscopia, reparación aguda del tendón de Aquiles, hallux valgus y fractura del 5.° metatarsiano.Conclusiones: Se recomienda un enfoque multimodal para la profilaxis de la trombosis venosa profunda. Esto incluye abordar los factores de riesgo modificables, mediante la profilaxis mecánica, la movilización temprana y la profilaxis química. La heparina de bajo peso molecular es eficaz para reducir la tasa de trombosis venosa profunda y tromboembolismo pulmonar. AbstractIntroduction: Deep vein thrombosis (DVT) is a major complication in orthopedic surgery. According to the literature, thromboprophylaxis in foot and ankle surgery is not a standardized practice due to the low incidence of DVT.Materials and Methods: We reviewed the medical records of surgical patients. Between 2011 and 2017, 1591 surgeries were performed, 6 of them due to symptomatic DVT.Results: The incidence of DVT in major orthopedic surgeries, such as knee and hip, is well documented, but there are only a few reports about its incidence in foot and ankle surgery. It is considered a relatively rare complication in many published studies; thus, preventive drug therapy is not routine practice.Conclusions: A multimodal approach to DVT prophylaxis for high-risk patients is recommended. All risk factors should be addressed, such as mechanical prophylaxis, early mobilization, and the use of chemoprophylaxis. Low molecular weight heparin is effective in reducing the rate of clinically significant DVT and is also likely to reduce the rate of pulmonary embolism.

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Long‐term patient outcome is affected by deep venous thrombosis after Achilles tendon rupture repair

Aufwerber,

Svedman,

Silbernagel

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of the study was to examine the impact of a deep venous thrombosis (DVT) on patient outcomes 3 years after Achilles tendon rupture (ATR) repair and if there were continued improvements between 1 and 3 years after surgery. A secondary aim was to determine risk factors associated with impaired patient outcomes in the long term.MethodsThis cohort study consisted of 181 ATR‐repaired patients, from two large randomized clinical trials, who attended a 3‐year follow‐up evaluation. Patients were postoperatively randomized to two different weight‐bearing interventions compared with immobilization in a below‐knee plaster cast for 2 weeks. During immobilization, screening for DVT was performed with Doppler ultrasound. At 1 and 3 years postoperatively, functional‐ and patient‐reported outcomes were evaluated by the validated heel‐rise test and self‐reported questionnaire, Achilles tendon Total Rupture Score (ATRS).ResultsIn total, 76 out of 181 (42%) patients exhibited a DVT at the 2‐ or 6‐week screening after ATR surgery. Suffering from a DVT during immobilization resulted at 3 years in a worse limb symmetry index (LSI) of heel‐rise total work compared to patients without DVT, adjusted for age (DVT mean LSI 68% vs. no DVT 78%, p = 0.027). At 3 years, patients with a DVT during immobilization displayed lower ATRS (DVT median 88 vs. no DVT 93, p = 0.046), which was not significant after adjustment for age. However, patients with DVT exhibited an improvement in ATRS, LSI total work, and LSI maximum height between 1 and 3 years, which was not seen among patients without DVT. Independent risk factors for reduced patient functional outcomes at 3 years were older age, greater calf muscle hypotrophy, and suffering a DVT.ConclusionsDVT during immobilization affects patients' long‐term functional outcomes 3 years after ATR repair. Clinicians should adequately address risk factors contributing to impaired patient outcomes in the long term, including calf muscle hypotrophy, DVT, and older age.Level of EvidenceLevel Ⅲ.

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American College of Foot and Ankle Surgeons' Clinical Consensus Statement: Risk, Prevention, and Diagnosis of Venous Thromboembolism Disease in Foot and Ankle Surgery and Injuries Requiring Immobilization

Cited by 47 publications

References 92 publications

The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

Trombosis venosa profunda en cirugías de tobillo y pie. Algoritmo de profilaxis [A prophylaxis algorithm for deep vein thrombosis in ankle and foot surgery]

Long‐term patient outcome is affected by deep venous thrombosis after Achilles tendon rupture repair

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