Foot & Ankle

Total ankle arthroplasty and VTE

x-ref Research

With large company-funded studies and significant consultancy arrangements with certain key opinion leaders, the naturally sceptical will tend to call into question the currently agreed wisdom that thromboprophylaxis is required for every patient, whatever their surgery or risk factors. Surprisingly, the usually litigation-heavy USA has some of the most liberal national guidance documents on thromboprophylaxis in orthopaedic surgery. Researchers in Durham (USA), however, were keen to test the assertion made by many national bodies that patients undergoing major orthopaedic surgery (including total ankle arthroplasty) should have thromboprophylaxis routinely. Their practice has been only to prescribe chemoprophylaxis when patients have a history of venous thromboembolism (VTE). Here they report their results of 637 serial patients with the outcome of clinically significant DVT or pulmonary embolism (PE) confirmed on Doppler or CTPA. The overall detection rate of DVT was tiny in this series, with just 0.45% developing a DVT and just 0.60% a PE. Interestingly, in their rather large series of 434 patients who were not prescribed chemoprophylaxis, there was no difference in the incidence of symptomatic VTE (0.46%) between this group and the remaining cohort.⁵ The conclusions reached by this study team are at odds with much national guidance but do seem to be sensible. If patients have risk factors for VTE then prophylaxis is recommended, but if they are low risk it may not be indicated.