Incidence of Venous Thromboembolism following Knee Arthroscopy: Effectiveness of a Risk-Based Stratified Chemoprophylaxis Protocol

Abstract

The incidence of symptomatic venous thromboembolism (VTE) has been reported in up to 10.9% of patients undergoing knee arthroscopy without chemoprohylaxis. The purpose of this study was to evaluate the effectiveness of a chemoprophylaxis protocol in patients undergoing knee arthroscopy. A retrospective review of prospectively enrolled patients in a new institutional VTE prophylaxis protocol identified all patients undergoing knee arthroscopy during a 5-year period. This risk-based chemoprophylaxis protocol was instituted based on the Caprini model: patients at more than minimal risk were prescribed enoxaparin 40 mg daily for 3 weeks, while all others were instructed to take aspirin 325 mg twice daily. The primary outcome measure was incidence of VTE within 60 days postoperatively. Demographic characteristics and other risk factors for VTE were also recorded, as well as any postoperative complications. Among the 1,276 knee arthroscopies, there were 26 VTE events (2.0%), including 23 with deep vein thrombosis (DVT), two pulmonary emboli (PE), and one patient with both DVT and PE. There were no deaths or complications requiring hospitalization or reoperation. The VTE diagnosis occurred at, on average, 9 days postoperatively. Patients in the high-risk group treated with enoxaparin had a lower VTE incidence (1.49%) than those instructed to take aspirin (2.0%); p = 0.75. Those undergoing an anterior cruciate ligament (ACL) reconstruction had the highest VTE incidence (2.87%). This study found that a chemoprophylaxis protocol with preferential use of aspirin or low–molecular weight heparin based on risk factors reduced the VTE incidence below to 2.0%, which is lower than most historical controls.

Local and Systemic Complications of Knee and Hip Arthroscopy: A Matched-Cohort Study

“…DVT after knee arthroscopy is documented in the literature at a rate of 2.0% of patients within 2 months after surgery, with the highest rates among ACL procedures. 29 This study found a DVT rate of 0.98% at 3 months after surgery, which was similar to previous studies. Comparatively, hip arthroscopy DVT incident rates have been reported at 0.76% and 1.4%, 1 , 13 while our study reported a rate of 0.66% at 3 months after surgery.…”

Recommendations from the ICM-VTE: General

“…Rationale: Patients undergoing orthopaedic surgery are at risk of VTE 2214-2221 . Rehabilitation including early ambulation is of utmost importance to prevent VTE 2222,2223 .…”

Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts

“…Consensus also could not be achieved for arguably the commonest knee arthroscopic surgery that is routinely performed, namely ACL reconstruction. There is published evidence that ACL reconstruction is associated with the maximum incidence of VTE following knee arthroscopy, followed closely by meniscal repair [ 33 ]. The panel could not reach consensus for meniscal repair as well, but through their comments indicated that VTE for single ligament reconstructions and meniscal repair is merited based solely upon patient factors.…”