Is DVT prophylaxis necessary after oncology lower limb surgery? A pilot study

Abstract

Background Deep vein thrombosis (DVT) has been independently associated with both malignant diseases and orthopaedic surgery. Therefore, orthopaedic oncology patients may be at a high risk for thromboembolic events. However, less emphasis is given to this group of patients compared to the patients undergoing total hip and knee replacement. The objective of this study is to determine the incidence of DVT and their risk factors in patients undergoing orthopaedic oncology lower limb surgery without prophylaxis.Questions/purposes(1) What is the incidence of DVT in patients who underwent orthopaedic oncology surgery for the lower limb? (2) What are the risk factors related to DVT in patients who underwent oncology surgery of the lower limb surgery? (3) This is a pilot study to determine if further trial is warranted.MethodsThis is a prospective study. All sequential patients undergoing orthopaedic oncology operations from the period of 1st October 2013 till 30th September 2014 were recruited for the study with their consent. Their demographic data, diagnosis and surgery were documented. Thirty-eight patients who underwent lower limb surgeries for orthopaedic oncology indications were included in the study. No tourniquet was used in these lower limb surgeries. There were 24 men and 14 women with a mean age of 36 years (11–75). All potential risk factors were also identified and documented. All patients were not given any form of DVT prophylaxis (mechanical and chemical) before and after operation as this is a standard protocol in our center and a Medical Ethics Committee approval was taken for this study. DVT surveillance was performed 1 day before operation and 2 weeks after operation with ultrasound Doppler. Patients diagnosed with DVT via ultrasound Doppler were subsequently scheduled for CTPA to look for pulmonary embolism (PE).ResultsDVT was detected in two patients (5 %). Both patients were asymptomatic and they both had proximal thrombosis. One patient (2.6 %) was diagnosed with non-fatal PE and was asymptomatic. PE was detected incidentally by staging computed tomography scan and the patient had negative ultrasound Doppler of the operated and non-operated limb for DVT. We did not carry out a statistical analysis as the study population with DVT and pulmonary embolism is small.ConclusionsThe incidence of DVT in patients after undergoing orthopaedic oncology lower limb surgery was low even without prophylaxis at our center. Further investigation with larger sample size is needed to validate our results and identify the risk factors.Level of evidenceLevel III descriptive study.

Retracted

“…[25] Previous studies have reported a higher risk of DVT and PE when they utilized TXA. This finding may be because of its antifibrinolytic effect.…”

“…DVT has been identified as a common complication that may develop into PE and even result in death following surgery. [ 25 ] Previous studies have reported a higher risk of DVT and PE when they utilized TXA. This finding may be because of its antifibrinolytic effect.…”

Preoperative Venous Thromboembolism in Orthopedic Oncology Patients: Incidence, Risk Factors, and D-Dimer Cutoff Value

“…Nineteen of 199 patients (9.5%) had VTE detected in this study. The incidence was higher than the rate of perioperative VTE reported in previous studies [10][11][12][13][14][15]. Several conditions that differed from those in previous studies may have in uenced the results.…”

“…Various factors, such as age, size and location of the tumor, chemotherapy, Ewing sarcoma family, metastasis, pathological fracture, and type of surgery, are suggested to be related to the occurrence of VTE [10][11][12][13][14][17][18][19][20]. However, most previous studies analyzed postoperative patients who underwent orthopedic surgery [10,[12][13][14][15][16][17]19]. In addition, routine screening for VTE was not considered, so the reported rate of VTE represented only those that were clinically symptomatic [12,14].…”

“…The combination of clinical symptoms, D-dimer, and contrast-enhanced computed tomography (CT) has made it possible to diagnose 97.9% of VTE cases [8,9]. The incidence of perioperative VTE in orthopedic oncology patients has been reported to range from 2.7% to 22% [10][11][12][13][14][15][16][17][18]. Various factors, such as age, size and location of the tumor, chemotherapy, Ewing sarcoma family, metastasis, pathological fracture, and type of surgery, are suggested to be related to the occurrence of VTE [10][11][12][13][14][17][18][19][20].…”