Recommendations from the ICM-VTE: Shoulder & Elbow

Abstract

The ICM-VTE Shoulder & Elbow Delegates* Question: 1 -Concerning VTE risk, which surgeries can be considered major, and which surgeries can be considered non-major in shoulder and elbow surgery?Response/Recommendation: Shoulder arthroscopy, nonfracture related shoulder arthroplasty, and all elbow procedures can be considered non-major venous thromboembolism (VTE) risk. Fracture related shoulder procedures can be considered major VTE risk.Strength of Recommendation: Limited.Delegates vote: Agree 93.94% Disagree 6.06% Abstain 0.00% (Strong Consensus)Rationale: VTE following shoulder and elbow surgery are rare events. One study reported for all upper extremity deep venous thromboses (DVT) to represent 1% to 4% of all DVT 1 . In the shoulder, surgeries can be divided into arthroscopic, non-fracture shoulder arthroplasty, and fracture related surgeries. In the elbow, surgeries can be divided into arthroscopy, fracture related, and arthroplasty. With respect to these surgeries, several studies have reported VTE rates, however, a majority of this information comes from a collection of level 3 and level 4 evidence along with registry studies.In shoulder arthroscopy, VTE rates are low with reported rates ranging from 0.011% to 0.38% 2-6 . Kuremsky et al., in a retrospective study of 2,872 patients undergoing shoulder arthroscopy reported VTE rate of 0.24% 2 . Jameson et al., in a registry study out of the United Kingdom reported 0.011% VTE rate in a retrospective review of 65,302 shoulder arthroscopy cases 3 . Similarly, Brislin et al., reported VTE rate of 0.38% in a consecutive series of 263 arthroscopic rotator cuff repairs (RCR) 4 . These VTE rates following arthroscopic RCR were similar to rates reported by Hoxie et al., (0.26%) 5 . Additionally, open instability surgeries also comprise higher VTE risk than their arthroscopic counterparts. Goodloe et al., in a registry study compared arthroscopic Bankart repair, open Bankart repair, and Latarjet-Bristow procedure with reported VTE rates of 0.1%, 0.0%, and 0.8%, respectively 7 . Thus, shoulder arthroscopy procedures can be considered non-major concerning VTE risk.

International consensus on prevention of venous thromboembolism in patients after orthopedic interventions

“…У березні 2022 року опубліковано нові міжнародні рекомендації щодо профілактики венозної тромбоемболії в пацієнтів після великих ортопедичних утручань (Recommendations from the International Consensus Meeting on Venous Thromboembolism) [1][2][3][4][5][6][7][8][9][10]. Передумовою для створення цього консенсусу послужила недосконалість наявних даних і рекомендацій щодо профілактики тромбоемболії в періопераційному періоді.…”

“…Рекомендації містять розділ зі загальними підходами тромбопрофілактики після ортопедичних утручань [1] та спеціалізованими, зокрема: у разі хірургії верхньої кінцівки та зап'ястка [2], плеча або ліктя [3], стопи або гомілки [4], стегна або коліна [5], хребта [6], за умов онкології [7], у випадку операцій у дітей [8], після ушкоджень [9] і спортивних травм [10].…”

Deep Venous Thrombosis of Non-operative Clavicle Fracture Following Low-Energy Injury Mechanism With Extension Into the Radial Vein: A Case Report

“…Thromboses associated with clavicle fractures are rare, and most cases are due to penetrating trauma or high-energy mechanism [1][2][3][4]. Upper extremity venous thromboembolisms (VTEs) only comprise 1-4% of all VTEs [5]. Additionally, there is limited to no evidence suggesting any association between VTE and immobilization of the upper extremity, as when clavicle fractures are treated with a sling [5].…”

“…Upper extremity venous thromboembolisms (VTEs) only comprise 1-4% of all VTEs [ 5 ]. Additionally, there is limited to no evidence suggesting any association between VTE and immobilization of the upper extremity, as when clavicle fractures are treated with a sling [ 5 ]. There are thus no official recommendations for VTE prophylaxis in regard to upper extremity immobilization [ 5 ].…”

“…Additionally, there is limited to no evidence suggesting any association between VTE and immobilization of the upper extremity, as when clavicle fractures are treated with a sling [ 5 ]. There are thus no official recommendations for VTE prophylaxis in regard to upper extremity immobilization [ 5 ]. VTE prophylaxis is only indicated for upper extremity fractures with risk factors for VTE such as hypercoagulability or bed confinement [ 5 ].…”