Thromboprophylaxis ‘not supported’ for ankle fracture surgery
MedWire News: Venous thromboembolism (VTE) is rare in patients who undergo ankle fracture surgery, say researchers who believe that routine use of thromboprophylaxis is unnecessary in this population.
"We would need to treat more than 370 patients to prevent one thromboembolic event, which is not very cost-effective," comment Stéphanie Pelet (CHUQ-Hotel Dieu de Quebec, Canada) and co-workers.
The team reviewed the incidence of VTE and risk factors for such events in 1540 ambulatory patients who required open reduction and internal fixation for ankle fracture at one of three hospitals between January 1997 and April 2005, and were followed-up for a minimum of 6 months.
Unimalleolar fractures were the most common type of injury (45%), followed by bimalleolar (31%), and trimalleolar (24%) fractures.
Symptomatic, imaging-confirmed VTE occurred in 46 (2.99%) patients, with 41 (2.66%) experiencing confirmed deep vein thrombosis (DVT), and five (0.32%) patients developing pulmonary embolism (PE). No patients died from PE events.
Analysis showed that 16.43% of patients had been given thromboprophylaxis during their hospital stay, with 10.78% of patients given low molecular weight heparin for 6 weeks, and 5.65% given warfarin for 3 months after discharge.
The incidence of DVT and PE was not significantly altered by receipt of thromboprophylaxis, with a rate of 2.37% and 0.40% for treated patients versus 2.56% and 0.47% for those not given antithrombotic agents.
Overall, 45.3% of patients had at least one risk factor for VTE, such as cancer, hormone use, pregnancy, history of VTE, smoking, obesity, or paralysis, and these patients had a significantly increased risk for events compared with patients without any risk factors (3.59 vs 2.38%).
However, thromboprophylaxis did not significantly reduce the risk for VTE regardless of whether or not patients had one or more VTE risk factors (3.68 vs 3.55%).
Nor was the risk for VTE altered by age, gender, fracture type, or trauma, the researchers report in the Journal of Bone and Joint Surgery.
Pelet et al therefore conclude that, in the absence of evidence, thromboprophylaxis use is not supported for patients undergoing ankle fracture surgery.
"It is also important to consider economic factors and complications resulting from thromboprophylaxis before supporting its routine use in patients with ankle fractures that have been treated operatively," they add.
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By Lynda Williams