VTE common after lower extremity amputation
MedWire News: One in seven patients undergoing lower extremity amputation experience venous thromboembolism (VTE) within 2 weeks of surgery, research from The Netherlands shows.
"Lower extremity amputation is often performed in patients with end-stage vascular disease and is considered a high-risk procedure," note Harmen Ettema (Isala Clinics, Zwolle) and colleagues.
They add that uncertainty regarding the true VTE rate among these patients exists because classic VTE symptoms such as redness, swelling, and warmth are often absent in an amputation stump, and this may therefore lead to an underestimation of the problem.
To establish the incidence of death and VTE after lower extremity amputation, Ettema and team monitored 49 patients (53 amputations) undergoing the procedure, for 8 weeks. All patients received standard low molecular weight heparin thromboprophylaxis during the study period.
VTE was assessed by bilateral complete compression ultrasonography and ventilation-perfusion scintigraphy at 1-3 days pre-operatively and around 14 days postoperatively.
Six (12.2%) patients developed pulmonary embolism (of which two cases were fatal) and one (2.0%) patient developed an asymptomatic contralateral distal deep venous thrombosis, resulting in a total VTE rate of 14.2%. All events occurred in the first 2 weeks postsurgery.
There were 12 (24.5%) deaths during the 8-week clinical follow-up period, five of which occurred in the first 2 weeks.
"This study shows that VTE substantially contributes to the morbidity and mortality after lower extremity amputation despite adequate pharmacological thromboprophylaxis in this vulnerable population of patients," write Ettema and co-authors in the Journal of Thrombosis and Haemostasis.
"A more aggressive thromboprophylactic regimen seems warranted," but the best approach is currently unclear, they conclude.
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By Laura Dean