Symptomatic Venous Thromboembolism After Adolescent Knee Arthroscopy

Murphy, Robert F.; Heyworth, Benton E.; Kramer, Dennis E.; Naqvi, Manahil; Miller, Patricia E.; Yen, Yi‐Meng; Kocher, Mininder S.; Shore, Benjamin J.

doi:10.1097/bpo.0000000000000894

Cited by 27 publications

(36 citation statements)

References 29 publications

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“…The incidence of DVT after major orthopedic surgery is relatively high; therefore, some form of thromboprophylaxis is provided for these patients. [1][2][3]7,20,21 However, the risk is not clear after AKS. 1,2,7,17 Since VTE is relatively low after AKS, routine thromboprophylaxis is not recommended after these operations.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Deep Vein Thrombosis Following Elective Knee Arthroscopy Over the Age of 40

Özcan

Erem

Turan

2019

Clin Appl Thromb Hemost

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Thromboprophylaxis following arthroscopic knee surgery (AKS) is not clear in the literature. The purpose of this study was to present the incidence of symptomatic deep vein thrombosis (DVT) following elective AKS over the age of 40. The secondary purpose was to investigate risk factors associated with venous thromboembolic events (VTEs). Surgical database and outpatient clinic follow-up charts of the patients who underwent AKS for any reason were included in the study. Odds for risk factors such as previous medical history of thrombosis, any family history for clotting disorders, diabetes mellitus (DM), oral contraceptive usage, body mass index, history of malignancy, and smoking were evaluated. The incidence of DVT following AKS significantly increased in the patients older than 40 years who had a previous medical history of VTE, DM, and smoking. A variety of guidelines exist for VTE prophylaxis; however, one should focus on risk factors related to the patient’s medical history and current medical conditions. In this study, smoking, DM, and previous history of DVT increased DVT risk significantly, and thromboprophylaxis should be kept in mind for these patients.

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Section: Discussionmentioning

confidence: 99%

Symptomatic Deep Vein Thrombosis Following Elective Knee Arthroscopy Over the Age of 40

Özcan

Erem

Turan

2019

Clin Appl Thromb Hemost

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“…We performed sensitivity analyses to explain the source of heterogeneity. Third, the clinical situation of the patients and the patients’ intrinsic risk factors[ 28 ] were not included, which may have affected the studied outcomes. Fourth, the types and doses[ 29 ] of LMWH or use of different times for patients were not considered in this study.…”

Section: Limitationsmentioning

confidence: 99%

Efficacy and safety of low-molecular-weight heparin after knee arthroscopy: A meta-analysis

et al. 2018

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BackgroundVenous thromboembolism (VTE) is considered a potentially serious complication of knee arthroscopy and leads to conditions such as deep venous thrombosis (DVT) and pulmonary embolism (PE). Low-molecular-weight heparin (LMWH) is widely employed in knee arthroscopy to reduce perioperative thromboembolic complications. However, the efficacy and safety of LMWH in knee arthroscopy remains unclear.MethodsSeven randomized controlled clinical trials on LMWH in knee arthroscopy were identified and included in this meta-analysis. The main outcomes of the effectiveness (prevention of DVT and PE) and complications (death, major bleeding, and minor bleeding) of LMWH in knee arthroscopic surgery were assessed using Review Manager 5.3 software.ResultsThe meta-analysis indicated that LMWH prophylaxis comprised 79% of asymptomatic DVT. No association was found in symptomatic VTE (RR: 0.90; 95% confidence interval [CI]: 0.39–2.08; P = 0.80), symptomatic DVT (RR: 0.79; 95% CI: 0.28–2.23; P = 0.66), symptomatic PE (RR: 1.36; 95% CI: 0.37–4.97; P = 0.64) and major bleeding (RR: 0.70; 95% CI: 0.12–3.95; P = 0.68) risk during LMWH prophylaxis were identified. Death was not reported in these studies. Moreover, there was a lower incidence of minor bleeding (RR: 0.64; 95% CI: 0.49 to 0.83; P = 0.001) in the control group than in the LMWH group.ConclusionCompared with the control group, the group treated with LMWH after knee arthroscopy was no association in reducing the symptomatic VTE rate, symptomatic DVT rate or symptomatic PE rate. The symptomatic VTE rate was 0.5% (11/2,166) in the LMWH group versus 0.6% (10/1,713) in the control group. Although the limitations of this meta-analysis cannot be ignored, the results of our study show that LMWH after knee arthroscopy is ineffective. We recommend that LMWH should not be routinely provided for knee arthroscopy.Trial registrationClinicalTrials.gov NCT03164746

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“…95,96 Respiratory distress could be due to a pulmonary embolism, although deep venous thrombosis is rare in children postoperatively. 97 In a case-control study, 98 obesity (BMI >95th percentile) was associated with increased risk of deep vein thrombosis in paediatric patients, and surgery was a cofactor; however, overweight status (BMI 85th to 95th percentile) was not associated with an increase in deep vein thrombosis. In one retrospective study 99 that included 117 176 patients, the prevalence of deep vein thrombosis after elective orthopaedic surgery was measured as 0•05% per admission to hospital.…”

Section: Reviewmentioning

confidence: 99%

“…When thromboembolic disease is confirmed, low-molecular-weight heparin appears to be effective. 97 Dosing antithrombotic therapy remains problematic, because little data are available on this subject and a pharmacokinetic-pharmacodynamic model has yet to be developed. The available data support lower doses of unfractionated heparin in paediatric patients who are overweight or obese, especially during continuous administration.…”

Section: Reviewmentioning

confidence: 99%

Peri-operative management of overweight and obese children and adolescents

Lejus¹,

Orliaguet

Servin

et al. 2017

The Lancet Child & Adolescent Health

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Obesity has become endemic, even in children. Systemic complications associated with obesity include metabolic syndrome, cardiovascular disease, and respiratory compromise. These comorbidities require adequate investigation, targeted optimisation, and, if surgery is required, specific management during the peri-operative period. Specific peri-operative strategies should be used for paediatric patients who are overweight or obese to prevent postoperative complications, and optimising the respiratory function during surgery is particularly crucial. This Review aims to provide up-to-date information on peri-operative management for physicians who are caring for children and adolescents (usually younger than 18 years) who are overweight or obese undergoing surgery, including bariatric surgery. We have particularly focussed on the physiological consequences of obesity-namely, obstructive sleep apnoea, respiratory compromise, and pharmacological considerations.

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Symptomatic Venous Thromboembolism After Adolescent Knee Arthroscopy

Abstract: Level IV.

Cited by 27 publications

References 29 publications

Symptomatic Deep Vein Thrombosis Following Elective Knee Arthroscopy Over the Age of 40

Symptomatic Deep Vein Thrombosis Following Elective Knee Arthroscopy Over the Age of 40

Efficacy and safety of low-molecular-weight heparin after knee arthroscopy: A meta-analysis

Peri-operative management of overweight and obese children and adolescents

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