Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery

Abstract

Purpose To perform a meta-analysis investigating venous thromboembolism (VTE) following isolated foot and ankle surgery and propose guidelines for VTE prevention in this group of patients.MethodsFollowing a PRISMA compliant search, 372 papers were identified and meta-analysis performed on 22 papers using the Critical Appraisal Skills Programme and Centre for Evidence-Based Medicine level of evidence.Results 43,381 patients were clinically assessed for VTE and the incidence with and without chemoprophylaxis was 0.6 % (95 % CI 0.4–0.8 %) and 1 % (95 % CI 0.2–1.7 %), respectively. 1666 Patients were assessed radiologically and the incidence of VTE with and without chemoprophylaxis was 12.5 % (95 % CI 6.8–18.2 %) and 10.5 % (95 % CI 5.0–15.9 %), respectively. There was no significant difference in the rates of VTE with or without chemoprophylaxis whether assessed clinically or by radiological criteria. The risk of VTE in those patients with Achilles tendon rupture was greater with a clinical incidence of 7 % (95 % CI 5.5–8.5 %) and radiological incidence of 35.3 % (95 % CI 26.4–44.3 %).ConclusionIsolated foot and ankle surgery has a lower incidence of clinically apparent VTE when compared to general lower limb procedures, and this rate is not significantly reduced using low molecular weight heparin. The incidence of VTE following Achilles tendon rupture is high whether treated surgically or conservatively. With the exception of those with Achilles tendon rupture, routine use of chemical VTE prophylaxis is not justified in those undergoing isolated foot and ankle surgery, but patient-specific risk factors for VTE should be used to assess patients individually.Level of evidenceII.

Venöz tromboembolizm risk faktörlerinin değerlendirilmesi

“…İzole ayak ve ayak bileği cerrahisi Calder ve ark. (2016) [36] Rutin kemoprofilaksi endikasyonu yoktur. A/Level 2…”

“…Calder ve ark. (2016) [36] Rutin mekanik anti-VTE metodların kullanımı. [40] • Aspirin ile kombine mekanik profilaksi.…”

Deep Vein Thrombosis in Combined Ankle Arthroscopy for the Anterior and Posterior Ankle Impingement Syndrome

“…According to the Caprini DVT risk factor assessment score (score 1: minor surgery planned) (8,18), it was decided not to use pharmacological DVT prophylaxis.…”

“…The risk of DVT for patients with isolated foot and ankle conditions, even with plaster cast immobilization, and the possible benefits of mechanical and chemical prophylaxis were poorly studied (8). Nevertheless, some studies mentioned risk factors as injury severity (9), immobilization (10), obesity (11), nonweight-bearing (12), hindfoot surgery (13), and tourniquet time (13).…”

Effect of Educational Guidelines for Prevention of Immobilization Complications on Caregivers' Performance and Patients' Functional Condition

“…Involvement of family caregivers is essential for optimal treatment of patients in ensuring treatment compliance, continuity of care and social support. It is necessary to understand that caregivers play an important role in providing care to their patients and they should be aware about the complications and their preventive measures [4].…”