VTE incidence low in foot and ankle surgery patients
MedWire News: Patients undergoing foot and ankle surgery are at low risk for venous thromboembolism (VTE), say UK researchers who believe thromboprophylaxis is only necessary in patients at high risk for thrombotic events.
"The reported risks of routine chemical thromboprophylaxis appear to outweigh any potential benefits and the use of aspirin does not appear to confer significant protection against symptomatic VTE," the team reports in the British volume of the Journal of Bone and Joint Surgery.
"An alternative form of thromboprophylaxis should be considered in high risk patients such as those who are obese, continue with the combined oral contraceptive pill or have a previous history of VTE or a pro-coagulant condition," the researchers add.
J Griffiths (Basingstoke and North Hampshire NHS Foundation Trust) and co-workers determined the incidence of symptomatic VTE in 2654 patients who underwent elective foot and ankle surgery between 2003 and 2010. All patients were treated with pneumatic compression foot pumps during surgery, and wore compression stockings postoperatively.
The 1078 patients who were treated between 2003 and 2006 were treated with once daily aspirin 75 mg from the day before surgery for 2 weeks for fore-foot procedures or 6 weeks for mid- or hind-foot procedures. The 1576 patients who underwent surgery between 2007 and 2010 were not given aspirin or other pharmaceutical thromboprophylaxis.
Overall, 11 (0.42%) patients developed symptomatic VTE, including seven (0.27%) cases of deep vein thrombosis (DVT), and four (0.15%) cases of non-fatal pulmonary embolism (PE). Twenty-seven patients were lost to follow-up; using a worst-case scenario, the incidence of VTE rose to 38 (1.43%) cases.
There was no significant difference in the incidence of symptomatic VTE, DVT, or PE between patients who did and did not receive aspirin, despite the study being powered to have a 79% likelihood of detecting a three-fold increase in the risk for VTE, Griffiths et al say.
However, the researchers note that VTE occurred an average of 5.7 weeks after surgery in patients given aspirin compared with just 3.7 weeks in untreated patients. Although this difference was not statistically significant, the authors suggest it would be "interesting to see the effect of aspirin on the incidence of a thromboembolic event in this patient group, if it was continued for a longer period of time post-operatively."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012
By Lynda Williams