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

Bavand Bikdeli; Renuka Visvanathan; David Jimenez; Manuel Monreal; Samuel Z. Goldhaber; Behnood Bikdeli

doi:10.1055/s-0039-1693464

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2019; 119(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

¹Aged & Extended Care Services, The Queen Elizabeth Hospital, Adelaide, Australia

²Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia

³Division of Medical Sub-specialties, Lyell McEwin Hospital, Adelaide, Australia

,

Renuka Visvanathan

¹Aged & Extended Care Services, The Queen Elizabeth Hospital, Adelaide, Australia

²Adelaide 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

⁴Respiratory and Medicine Department, Hospital Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain

,

Manuel Monreal

⁵Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona

⁶Universidad Católica de Murcia, Murcia, Spain

,

Samuel Z. Goldhaber

⁷Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States

,

Behnood Bikdeli

⁵Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona

⁸Division of Cardiology, Department of Medicine, Columbia University Medical Center/NewYork–Presbyterian Hospital, New York, New York, United States

⁹Center for Outcomes Research & Evaluation, Yale New Haven Hospital, New Haven, Connecticut, United States

› Author Affiliations

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.

Keywords

venous thromboembolism - foot or ankle surgery - prophylaxis - systematic review - meta-analysis

Full Text

References

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Supplementary Material