Prophylaxis of deep-vein thrombosis in fractures below the knee

Abstract

The incidence of deep-vein thrombosis and the need for thromboprophylaxis following isolated trauma below the knee is uncertain. We have investigated this with a prospective randomised double-blind controlled trial using low molecular weight heparin with saline injection as placebo in patients aged between 18 and 75 years who had sustained an isolated fracture below the knee which required operative fixation. All patients had surgery within 48 hours of injury and were randomised to receive either the placebo or low molecular weight heparin for 14 days, after which they underwent bilateral lower limb venography, interpreted by three independent radiologists. Further follow-up was undertaken at two, six, eight and 12 weeks. A total of 238 patients fulfilled all the inclusion criteria, with 127 in the low molecular weight heparin group and 111 in the placebo group, all of whom underwent bilateral venography. There was no statistically significant difference in the incidence of deep-vein thrombosis between those patients treated with low molecular weight heparin or the placebo (p = 0.22). The number of deep-vein thromboses in the two groups was 11 (8.7%) and 14 (12.6%), respectively. Age and the type of fracture were significantly associated with the rate of deep-vein thrombosis (p = 0.001 and p = 0.009, respectively) but gender, comorbidities and the body mass index were not. The overall incidence of deep-vein thrombosis in this series was 11%. There was no clinical or statistical significant reduction in the incidence of deep-vein thrombosis with the use of thromboprophylaxis. However, we accept that owing to a cessation of funding, recruitment to this trial had to be ended prior to establishing the necessary sample size. Our results cannot, therefore, categorically exclude the possibility that low molecular weight heparin treatment could be beneficial. We recommend a further multicentre trial be undertaken to resolve this matter.

Incidence of Preoperative Deep Vein Thrombosis in Calcaneal Fractures

“…We found increasing age to be a risk factor for the presence of a DVT, as have others [9,10,[12][13][14] . Although we collected data on other potential risk factors, none of these attained statistical significance in multiple logistic regression.…”

The incidence of deep vein thrombosis and pulmonary embolism after fracture of the tibia: An analysis of the National Trauma Databank

“…A prospective randomized controlled trial by Goel et al showed no significant difference in the incidence of DVT with chemical prophylaxis or placebo in fractures below the knee, although tibia plateau fractures showed a trend towards increased risk of VTE. 9 Unfortunately their study was prematurely closed due to lack of funding. The incidence of VTE after tibia fracture is believed to be low.…”

Oral anticoagulants for primary prevention, treatment and secondary prevention of venous thromboembolic disease, and for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis and cost-effectiveness analysis

“…patient population (with 20 associated references [153][154][155][158][159][160][164][165][166]174,176,177,179,181,183,186,189,[192][193][194] ), 17 trials in knee surgery patient population (with 18 associated references 152,156,157,[161][162][163][167][168][169][171][172][173]175,178,180,182,187,196 ), seven trials in medical patient population (with seven associated references 170,184,185,188,190,191,197 ) and one trial (with one associated reference 195 ) involving both hip and knee surgery patients. Thirty-nine of the trials were multicentre and four were single-centre trials.…”