Venous Thromboembolism Prophylaxis in Arthroscopic Surgery

Abstract

The prophylaxis and epidemiology of venous thromboembolism (VTE) following major orthopaedic procedures has been widely discussed in the world literature. Significantly less attention in the recent years has been paid to antithrombotic prophylaxis following arthroscopic procedures. In the past few years numerous controversies have developed as a result of contradictory guidelines advocated by various centres. Clinical studies involving prospective patient groups result in guidelines being published by orthopaedic associations. The guidelines issued by the Ame-rican College of Chest Physicians (ACCP) are the most influential. The latest edition of the guidelines was published in 2012. The National Institute for Health and Clinical Excellence (NICE) is a British centre which issues guidelines for antithrombotic prophylaxis. The latest version of the guidelines is the Clinical Guidelines (CG) 92, dated 2010. Polish guidelines were developed by a working group headed by Prof. Krystyna Zawilska. The Polish Society of Orthopaedics and Traumatology (PSOT) has not endorsed or recommended the guidelines put forward by the Working Group in 2012, so the PSOT guidelines are valid regarding orthopaedics and arthroscopic procedures. The comparison of international and Polish guidelines indicates a considerable discrepancy between the approaches to antithrombotic prophylaxis in arthroscopic procedures. From the viewpoint of an orthopaedist it is most important to select a prophylactic procedure appropriate for a specific patient. It is necessary to explain the need of prophylaxis to the patient, assess the risk factors of thrombosis and employ reliable tools, such as Wells' score. Pharmacological prophylaxis is well-known and widely used in arthroscopic procedures in Polish centres. However, it is also important to implement mechanical prophylactic measures, which are neglected or used to a limited extent in numerous centres. In recent years, American researchers conducted studies of large groups of patients with regard to the prophylaxis and incidence of VTE following arthroscopic procedures of the knee, hip and shoulder. The incidence of VTE following knee, hip and shoulder arthroscopy was 0.42%, 3.7% and 0.31%, respectively. The findings of the study support the validity of the guidelines issued by the American College of Chest Physicians in 2012.

Thromboprophylactic Efficacy and Safety of Anticoagulants After Arthroscopic Knee Surgery: A Systematic Review and Meta-Analysis

“…Most doctors in Germany use anticoagulants as a routine thromboprophylaxis measurement according to a questionnaire, 16 while The American College of Chest Physicians (ACCP) only recommend the use of anticoagulants after KA on patients with risk factors. 17 On the other hand, The American Academy of Orthopaedic Surgeons (AAOS) and The National Institute for Clinical Health and Excellence of United Kingdom haven't given any recommendation on the thromboprophylaxis after KA. 18 Recently, several large sample size randomized controlled trials (RCTs) have been conducted to explore the necessity of anticoagulants after KA.…”

Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts

“…Additionally, available guidelines in many cases provide contradictory recommendations regarding the appropriate use of VTE prophylaxis. [ 2 ]. Available literature on thromboembolic complications following knee arthroscopy is primarily case report level data [ 9 , 15 , 18 , 24 , 30 , 31 , 38 ].…”

Recommendations from the ICM-VTE: Shoulder & Elbow

“…Guidelines have been formulated for higher risk procedures in the lower limb, e.g., hip, and knee arthroplasty, but given the lower risk in the upper limb (even considering shoulder arthroplasty) these guidelines are not directly transferrable. Generalized rather than specific risk stratification tools have been created to help guide whether a patient is at higher risk of deep venous thrombosis (DVT), but there is a paucity of evidence to support these risks when considering upper limb surgery, in particular the risk of developing upper extremity VTE [31][32][33][34] .…”