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Low incidence of symptomatic thromboembolic events after total ankle arthroplasty without routine use of chemoprophylaxis.

Publication ,  Journal Article
Horne, PH; Jennings, JM; DeOrio, JK; Easley, ME; Nunley, JA; Adams, SB
Published in: Foot Ankle Int
June 2015

BACKGROUND: There is little evidence regarding the incidence of symptomatic venous thromboembolism (VTE) following total ankle arthroplasty (TAA) to allow formulation of treatment recommendations. The purpose of this study was to determine the incidence of symptomatic VTE events after TAA without use of chemoprophylaxis and to identify risk factors contributing to the occurrence of VTEs. METHODS: We conducted a retrospective chart review of 637 patients (664 ankles) who received a TAA between May 2007 and January 2014 and had a minimum follow-up of 3 months. Chemoprophylaxis was prescribed only in the setting of a history of VTE or active coagulopathy. Patients were continued on chemoprophylactic agents if they were taking these medications preoperatively. A VTE event was defined when clinical signs and symptoms of deep venous thrombosis (DVT) were confirmed with use of Doppler ultrasonography or pulmonary embolism was confirmed with the use of a computed tomography scan. Routine screening for VTE was not performed. RESULTS: The overall incidence of clinically detected VTE events was 0.60% (4/664), with 0.45% (3 patients) developing a DVT and 0.15% (1 patient) developing a nonfatal pulmonary embolism. Moreover, we identified a subset of 434 patients without identifiable preoperative risk factors who were not taking chemoprophylaxis preoperatively and were not prescribed chemoprophylaxis postoperatively. Two of these patients developed a DVT postoperatively (0.46%). Given the low incidence of clinically detected VTE, no significant correlation could be identified between the occurrence of VTE events and risk factors. CONCLUSIONS: Our results suggest that clinically detectable VTE after TAA is uncommon. Patients without identifiable risk factors do not appear to require chemoprophylaxis following TAA. We recommend continuation of antiplatelet or anticoagulation therapy in patients who are taking these medications preoperatively and the initiation of chemoprophylaxis postoperatively in patients with known risk factors for VTE. LEVEL OF EVIDENCE: Level IV, case series.

Duke Scholars

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

June 2015

Volume

36

Issue

6

Start / End Page

611 / 616

Location

United States

Related Subject Headings

  • Young Adult
  • Venous Thromboembolism
  • Risk Factors
  • Retrospective Studies
  • Pulmonary Embolism
  • Orthopedics
  • Middle Aged
  • Male
  • Incidence
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Horne, P. H., Jennings, J. M., DeOrio, J. K., Easley, M. E., Nunley, J. A., & Adams, S. B. (2015). Low incidence of symptomatic thromboembolic events after total ankle arthroplasty without routine use of chemoprophylaxis. Foot Ankle Int, 36(6), 611–616. https://doi.org/10.1177/1071100715573717
Horne, Phillip H., Jason M. Jennings, James K. DeOrio, Mark E. Easley, James A. Nunley, and Samuel B. Adams. “Low incidence of symptomatic thromboembolic events after total ankle arthroplasty without routine use of chemoprophylaxis.Foot Ankle Int 36, no. 6 (June 2015): 611–16. https://doi.org/10.1177/1071100715573717.
Horne PH, Jennings JM, DeOrio JK, Easley ME, Nunley JA, Adams SB. Low incidence of symptomatic thromboembolic events after total ankle arthroplasty without routine use of chemoprophylaxis. Foot Ankle Int. 2015 Jun;36(6):611–6.
Horne, Phillip H., et al. “Low incidence of symptomatic thromboembolic events after total ankle arthroplasty without routine use of chemoprophylaxis.Foot Ankle Int, vol. 36, no. 6, June 2015, pp. 611–16. Pubmed, doi:10.1177/1071100715573717.
Horne PH, Jennings JM, DeOrio JK, Easley ME, Nunley JA, Adams SB. Low incidence of symptomatic thromboembolic events after total ankle arthroplasty without routine use of chemoprophylaxis. Foot Ankle Int. 2015 Jun;36(6):611–616.
Journal cover image

Published In

Foot Ankle Int

DOI

EISSN

1944-7876

Publication Date

June 2015

Volume

36

Issue

6

Start / End Page

611 / 616

Location

United States

Related Subject Headings

  • Young Adult
  • Venous Thromboembolism
  • Risk Factors
  • Retrospective Studies
  • Pulmonary Embolism
  • Orthopedics
  • Middle Aged
  • Male
  • Incidence
  • Humans