Low molecular weight heparin for prevention of venous thromboembolism in patients with lower leg immobilization

Testroote, M.J.; Stigter, Willem AH; Janzing, H; Visser, D de

doi:10.1002/14651858.cd006681

Cited by 40 publications

(78 citation statements)

References 3 publications

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“…This risk may be modifiable. Existing evidence suggests that pharmacological prophylaxis could reduce overall VTE event rates in these patients, but the proportional reduction of symptomatic events remains unclear . Recent randomized controlled trials (RCTs) have used different pharmacological agents (low molecular weight heparin [LMWH] and fondaparinux), dosing regimens and outcome measures .…”

Section: Introductionmentioning

confidence: 99%

Pharmacological thromboprophylaxis to prevent venous thromboembolism in patients with temporary lower limb immobilization after injury: systematic review and network meta‐analysis

Horner

Stevens

Pandor

et al. 2020

Journal of Thrombosis and Haemostasis

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Background: Thromboprophylaxis has the potential to reduce venous thromboembolism (VTE) following lower limb immobilization resulting from injury. Objectives:We aimed to estimate the effectiveness of thromboprophylaxis, compare different agents, and identify any factors associated with effectiveness. Methods:We undertook a systematic review and network meta-analysis (NMA) of randomized trials reporting VTE or bleeding outcomes that compared thromboprophylactic agents with each other or to no pharmacological prophylaxis, for this indication. An NMA was undertaken for each outcome or agent used, and a series of study-level network meta-regressions examined whether population characteristics, type of injury, treatment of injury, or duration of thromboprophylaxis were associated with treatment effect. Results: Data from 6857 participants across 13 randomized trials showed that, compared with no treatment, low molecular weight heparin (LMWH) reduced the risk of any VTE (odds ratio [OR]: 0.52; 95% credible interval [CrI]: 0.37-0.71), clinically detected deep vein thrombosis (DVT) (OR: 0.39; 95% CrI: 0.12-0.94) and pulmonary embolism (PE) (OR: 0.16; 95% CrI: 0.01-0.74), whereas fondaparinux reduced the risk of any VTE (OR: 0.13; 95% CrI: 0.05-0.30) and clinically detected DVT (OR: 0.10; 95% CrI: 0.01-0.86), with inconclusive results for PE (OR: 0.40; 95% CrI: 0.01-7.53).Conclusions: Thromboprophylaxis with either fondaparinux or LMWH appears to reduce the odds of both asymptomatic and clinically detected VTE in people with temporary lower limb immobilization following an injury. Treatment effects vary by outcome and are not always conclusive. We were unable to identify any treatment effect modifiers other than thromboprophylactic agent used.

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Section: Introductionmentioning

confidence: 99%

Pharmacological thromboprophylaxis to prevent venous thromboembolism in patients with temporary lower limb immobilization after injury: systematic review and network meta‐analysis

Horner

Stevens

Pandor

et al. 2020

Journal of Thrombosis and Haemostasis

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“…To add further context, the most recent Cochrane meta‐analysis of randomized controlled trials (RCTs) of LMWH for prevention of VTE in patients with lower leg immobilization reports a mean incidence of VTE of 18% with a range between 4% and 40% in the placebo groups . The higher rates in this systematic review are attributable to the RCTs utilizing radiologic screening for VTE events, rather than a retrospective review of medical records for symptomatic events.…”

Section: Discussionmentioning

confidence: 92%

“…With the exception of one patient, no VTE prophylaxis was prescribed during the period of immobilization. As prophylaxis with medications such as low molecular weight heparin (LMWH) and aspirin reduces the risk of VTE in a number of orthopedic settings , the study investigators recommended that consideration be given to the routine administration of such chemoprophylaxis, stratified by VTE risk. The use of LMWH for this clinical situation is not funded in New Zealand, so a policy was set in place by the Orthopaedic Department that all patients who were managed with lower limb cast immobilization, including but not limited to Achilles tendon injury, would receive a prescription for a 6‐week course of enteric‐coated aspirin, 100 mg daily, for VTE prophylaxis, unless patient risk factors suggested that more aggressive prophylaxis was indicated.…”

Section: Introductionmentioning

confidence: 99%

Venous thromboembolism rates in patients with lower limb immobilization after Achilles tendon injury are unchanged after the introduction of prophylactic aspirin: audit

Braithwaite

Dunbar

Eathorne

et al. 2016

Journal of Thrombosis and Haemostasis

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To cite this article: Braithwaite I, Dunbar L, Eathorne A, Weatherall M, Beasley R. Venous thromboembolism rates in patients with lower limb immobilization after Achilles tendon injury are unchanged after the introduction of prophylactic aspirin: audit. J Thromb Haemost 2016; 14:331-5. Essentials• We audited venous thromboembolism (VTE) in Achilles injuries after the use of prophylactic aspirin.• We audited 218 patients with Achilles injury requiring lower limb immobilization for ≥ 1 week.• Fourteen patients (6.4%, 95% CI 3.6% to 10.5%) developed symptomatic and confirmed VTE.• The incidence was similar to the 6.3% identified in the same patient group prior to the use of aspirin.Summary. Background/Objective: We report a follow-up audit of the incidence of venous thromboembolism (VTE) in patients requiring lower limb immobilization because of Achilles tendon injury, since the introduction of a policy to routinely prescribe 100 mg of aspirin daily. , and one PE with distal DVT). Aspirin was prescribed to all patients who subsequently developed a VTE; in one of 14, a recognized risk factor was documented. The VTE incidence was similar to the 6.3% identified in the previous audit. Conclusion: Lower limb immobilization following Achilles tendon injury confers a high risk of VTE even with aspirin prophylaxis. Consideration should be given to prophylaxis with low molecular weight heparin during lower limb immobilization following Achilles tendon injury, as this has proven efficacy in this clinical situation.

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“…Alçı ile immobilizasyon Testroote ve ark. (2014) [37] DMAH Orta düzey kanıt Zee ve ark. (2017) [38] NICE (2018)…”

Section: Nice (2018)unclassified

Venöz tromboembolizm risk faktörlerinin değerlendirilmesi

Koçyiğit¹,

Atilla²

2019

TOTBID

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Türk Ortopedi ve Travmatoloji Birliği Derneği yaklaşık %10'u PTE'ye bağlıdır. [3] Hastaneye yatanlarda fatal PTE görülme sıklığı, elektif genel cerrahi operasyonu sonrası %0,1-0,8, elektif kalça protezi sonrası %2-3, kalça kırığına yönelik cerrahi sonrası ise %4-7'dir. [4] Tanı konulduktan sonra bir ay içinde ölüm oranı DVT hastalarında %6, PTE hastalarında %12'dir. [5] Bu nedenle VTE, önlem alınmazsa, hastane morbidite ve mortalitesinin en önemli nedenidir. [6-8] VTE riski, gerek cerrahi kliniklerde gerekse dahili kliniklerde bilinmesine V enöz tromboembolizmin (VTE) nedeni, çoğunlukla bacak derin venlerinde oluşan trombüslerdir. Bu trombüslerden bir kısmı koparak dolaşım yolu ile akciğerlere gelir ve pulmoner tromboembolizme yol açar. Venöz tromboemboli (VTE) derin ven trombozu (DVT) ve pulmoner tromboembolizm (PTE) hastalıklarını da içeren, yıllık insidansı erişkin popülasyonda %0,1-0,3 olan potansiyel fatal bir hastalıktır. [1] Akut dahiliye ve cerrahi hastalarında sık görülen bir komplikasyondur. [2,3] Hastane ölümlerinin Venöz tromboembolizm risk faktörlerinin değerlendirilmesi

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Low molecular weight heparin for prevention of venous thromboembolism in patients with lower leg immobilization

Cited by 40 publications

References 3 publications

Pharmacological thromboprophylaxis to prevent venous thromboembolism in patients with temporary lower limb immobilization after injury: systematic review and network meta‐analysis

Pharmacological thromboprophylaxis to prevent venous thromboembolism in patients with temporary lower limb immobilization after injury: systematic review and network meta‐analysis

Venous thromboembolism rates in patients with lower limb immobilization after Achilles tendon injury are unchanged after the introduction of prophylactic aspirin: audit

Venöz tromboembolizm risk faktörlerinin değerlendirilmesi

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