The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

Saragas, Nikiforos Pandelis; Ferrao, Paulo N. F.; Jacobson, Barry; Saragas, E; Strydom, A

doi:10.7196/samj.2017.v107i4.10843

Cited by 16 publications

(15 citation statements)

References 34 publications

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“…Some authors concluded that hip fractures presented with a highest incidence of 17-58% 6 , the incidence in distal femur fractures treated surgically was 25% 7 , and in foot and ankle surgery was 2.1%. 3 It seems that DVT may occur more often in the proximal fracture of lower extremity, and we speculate that fracture site may be correlated closely with the incidence of DVT in lower extremities. However, the abovementioned studies which came from different countries were carried out by different medical centers.…”

Section: Introductionmentioning

confidence: 63%

“… 2 It is estimated that 200 000 people die from pulmonary embolism each year. 3 In clinical practice, DVT is often asymptomatic and in many patients the fatal pulmonary embolism is usually the first clinical manifestation. 4 Many prophylactic methods for DVT, such as low dose heparin, aspirin, elastic stockings and intermittent pneumatic calf compression, have been employed widely in orthopedics department, but DVT is still a common dangerous postoperative complication.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of the occurrence of deep venous thrombosis in lower extremity fractures: A clinical study

Chen

Wang

et al. 2018

Pak J Med Sci

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Objective:To clarify if fracture site is correlated to the occurrence of deep venous thrombosis, and determine the risk factors of deep venous thrombosis in lower extremity fractures, help surgeons make prophylaxis for the disease correctly.Methods:The patients with lower extremity fractures treated surgically in the orthopedics department of our hospital from May 2012 to July 2017 were reviewed retrospectively. The clinical data including age, gender, fracture site, surgery modality, hospital stay, operation time, occupation type, hypertension, coronary heart disease, diabetes, smoking status, drinking status, postoperative exercises were collected and analyzed.Results:Eight hundred and twenty-nine patients were included for analysis, in which 68 were included in deep venous thrombosis group, 761 were included in the non-deep venous thrombosis group, and the incidence of deep venous thrombosis was 8.2%. There were significant differences in age, fracture site, surgery modality, occupation type, operation time, smoking status, hospital stay and postoperative exercises between the two groups (p<0.05), but no significant differences in gender, drinking status, coronary heart disease, diabetes and hypertension (p>0.05). In multivariate analysis, old age greater than 50 years, arthroplasty and operation time more than three hours were independent risk factors, while physical labor and postoperative exercises were protective factors for deep venous thrombosis in lower extremity fractures.Conclusion:Fracture site was correlated to the incidence of deep venous thrombosis, old age, longer operation time, and arthroplasty were independent risk factors, physical labor and postoperative exercises were protective factors for deep venous thrombosis in patients with lower extremity fractures.

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Section: Introductionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Analysis of the occurrence of deep venous thrombosis in lower extremity fractures: A clinical study

Chen

Wang

et al. 2018

Pak J Med Sci

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“…Según un reciente metanálisis de Martel y cols., el síndrome de trombocitopenia inducida por heparina también es una posible complicación con un riesgo absoluto en la cirugía ortopédica del 0,2% para la heparina de bajo peso molecular y del 2,6% para la heparina no fraccionada. 33,34 conclusIones Dos conceptos parecen claros hoy: 1) no todos los pacientes con trauma de pie y tobillo requieren profilaxis para la TVP y 2) las complicaciones potenciales de la TVP en la cirugía de pie y tobillo son serias y no pueden ser ignoradas.…”

Section: Resultsunclassified

Trombosis venosa profunda en cirugías de tobillo y pie. Algoritmo de profilaxis [A prophylaxis algorithm for deep vein thrombosis in ankle and foot surgery]

Masaragian¹,

Perin²,

Coria³

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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Introducción: La enfermedad tromboembólica es una de las complicaciones serias en la cirugía ortopédica. La tromboprofilaxis para las cirugías de tobillo y pie no está estandarizada, porque la incidencia es baja, según la bibliografía. El objetivo de este estudio es aportar un algoritmo de prevención para la trombosis venosa profunda y una revisión de la bibliografía.Materiales y Métodos: Se llevó a cabo una revisión de las historias clínicas de los pacientes operados entre 2011 y 2017. La muestra estaba integrada por 696 hombres (28,98%) y 1706 mujeres (71,02%), con un promedio de edad de 51 años (rango 20-82). Se realizaron 2402 procedimientos, 575 (23,94%) fueron por patologías traumáticas y 1827 (76,06%), por patologías ortopédicas.Resultados: Nueve pacientes (0,37%) presentaron trombosis venosa profunda y solo dos, tromboembolismo pulmonar (0,08%). Los procedimientos en los que ocurrieron fueron: artroscopia, reparación aguda del tendón de Aquiles, hallux valgus y fractura del 5.° metatarsiano.Conclusiones: Se recomienda un enfoque multimodal para la profilaxis de la trombosis venosa profunda. Esto incluye abordar los factores de riesgo modificables, mediante la profilaxis mecánica, la movilización temprana y la profilaxis química. La heparina de bajo peso molecular es eficaz para reducir la tasa de trombosis venosa profunda y tromboembolismo pulmonar. AbstractIntroduction: Deep vein thrombosis (DVT) is a major complication in orthopedic surgery. According to the literature, thromboprophylaxis in foot and ankle surgery is not a standardized practice due to the low incidence of DVT.Materials and Methods: We reviewed the medical records of surgical patients. Between 2011 and 2017, 1591 surgeries were performed, 6 of them due to symptomatic DVT.Results: The incidence of DVT in major orthopedic surgeries, such as knee and hip, is well documented, but there are only a few reports about its incidence in foot and ankle surgery. It is considered a relatively rare complication in many published studies; thus, preventive drug therapy is not routine practice.Conclusions: A multimodal approach to DVT prophylaxis for high-risk patients is recommended. All risk factors should be addressed, such as mechanical prophylaxis, early mobilization, and the use of chemoprophylaxis. Low molecular weight heparin is effective in reducing the rate of clinically significant DVT and is also likely to reduce the rate of pulmonary embolism.

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“…Moreover, the accumulation of coagulation factors leads to the overactivation of the coagulation system, thereby leading to accelerated thrombosis [9,[13][14][15] . However, once the venous thrombosis of lower extremities is formed, due to changes in the body position or local massage factors, the thrombosis tends to fall off and form fatal PE; it has been reported that 10% of patients with DVT develop fatal PE [16] . It is therefore necessary to solve the problem of DVT in lower extremity fractures before operation.…”

Section: Discussionmentioning

confidence: 99%

Study on the Risk Factors of Deep Vein Thrombosis (DVT) in Patients With Lower Extremity Fracture

Chang

Wang

et al. 2020

Preprint

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Abstract Background:The objective of this work is to discuss and analyze the related factors of lower extremity fracture complicated by deep vein thrombosis (DVT), and to help surgeons aptly prevent it.Methods:A retrospective analysis was conducted on the orthopedic inpatient records of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from July 2014 to November 2018, and 11,891 patients with closed fractures of lower extremities were selected.By analyzing each patient's gender, age, presence or absence of diabetes and hypertension,preoperative plasma D-dimer level, and color Doppler ultrasound of the lower extremity vein, the pertinent factors of the patients with lower extremity fractures complicated by DVT were analyzed.Results: A total of 11,891 patients were selected, including 4462 with cases of peri-hip fractures, 754with cases of femoral shaft fractures, 1776 with cases of peri-knee fractures, 1961 with cases of tibiofibular fractures, and 2938 with cases of ankle fractures.Of these patients, 643 with DVT were detected, displaying a total incidence of 5.4%.All patients were categorized into either the DVT group or non-DVT group.The results demonstrate that there were statistically significant differences between the two groups in age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level (p<0.05), but there was no statistically significant difference in sex (p>0.05). Logistic multivariate analysis revealed that age, the presence of diabetes, and the preoperative plasma D-dimer level of patients were independent risk factors for lower extremity fracture complicated by DVT.Conclusion: Age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level were found to be correlated with the incidence of DVT. Moreover,age, the presence of diabetes, the preoperative fracture site, and the plasma D-dimer level were found to be independent risk factors.

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The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

Cited by 16 publications

References 34 publications

Analysis of the occurrence of deep venous thrombosis in lower extremity fractures: A clinical study

Analysis of the occurrence of deep venous thrombosis in lower extremity fractures: A clinical study

Trombosis venosa profunda en cirugías de tobillo y pie. Algoritmo de profilaxis [A prophylaxis algorithm for deep vein thrombosis in ankle and foot surgery]

Study on the Risk Factors of Deep Vein Thrombosis (DVT) in Patients With Lower Extremity Fracture

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