Thromb Haemost 2019; 19(10): 1686-1694
DOI: 10.1055/s-0039-1693464
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Use of Prophylaxis for Prevention of Venous Thromboembolism in Patients with Isolated Foot or Ankle Surgery: A Systematic Review and Meta-Analysis

Bavand Bikdeli
1  Aged & Extended Care Services, The Queen Elizabeth Hospital, Adelaide, Australia
2  Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia
3  Division of Medical Sub-specialties, Lyell McEwin Hospital, Adelaide, Australia
,
Renuka Visvanathan
1  Aged & Extended Care Services, The Queen Elizabeth Hospital, Adelaide, Australia
2  Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia
,
David Jimenez
4  Respiratory and Medicine Department, Hospital Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain
,
Manuel Monreal
5  Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona
6  Universidad Católica de Murcia, Murcia, Spain
,
Samuel Z. Goldhaber
7  Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Behnood Bikdeli
5  Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona
8  Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork–Presbyterian Hospital, New York, New York, United States
9  Center for Outcomes Research & Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States
› Author Affiliations
Funding None.
Further Information

Publication History

01 August 2018

06 June 2019

Publication Date:
20 August 2019 (eFirst)

Abstract

Although prophylaxis for venous thromboembolism (VTE) is recommended after many surgeries, evidence base for use of VTE prophylaxis after foot or ankle surgery has been elusive, leading into varying guidelines recommendations and notable practice variations. We conducted a systematic review of the literature to determine if use of VTE prophylaxis decreased the frequency of subsequent VTE, including deep vein thrombosis (DVT) or pulmonary embolism (PE), compared with control. We searched PubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through May 2018, for randomized controlled trials (RCTs) or prospective controlled observational studies of VTE prophylaxis in patients undergoing foot and ankle surgery. Our search retrieved 263 studies, of which 6 were finally included comprising 1,600 patients. Patients receiving VTE prophylaxis had lower risk for subsequent DVT (risk ratio [RR]: 0.72; 95% confidence interval [CI]: 0.55–0.94) and subsequent VTE (RR: 0.72; 95% CI: 0.55–0.94). There was only one case of nonfatal PE, no cases of fatal PE, and no change in all-cause mortality (RR: 3.51; 95% CI: 0.14–84.84). There was no significant difference in the risk for bleeding (RR: 2.12; 95% CI: 0.53–8.56). Very few RCTs exist regarding the efficacy and safety of VTE prophylaxis in foot and ankle surgery. Prophylaxis appears to reduce the risk of subsequent VTE, but the event rates are low and symptomatic events are rare. Future studies should determine the subgroups of patients undergoing foot or ankle surgery in whom prophylaxis may be most useful.

Supplementary Material