Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts
Raju Easwaran,corresponding author1,2 Moin Khan,3 Parag Sancheti,4 Ashok Shyam,5 Mohit Bhandari,6 Anil S. Ranawat,7 Savyasachi Thakkar,8 Shital Parikh,9 Volker Musahl,10 Siddharth Joglekar,11,12 Ajit J.Deshmukh,13 Kevin Plancher,14,15,16,17 Nikhil Verma,18 David McAllister,19,20 Peter Verdonk,21,22 Sebastien Lustig,23 Amit Chandrateya,24 Robert Smigleiski,25 Gandhi Solayar,26 Bancha Chernchujit,27 Patrick Yung,28 Nicolaas Budhiparama,29,30,31 Yuichi Hoshino,32 Nathan White,33 David Parker,34 Mark Clatworthy,35 Charlie Brown,36 Mojieb Manzary,37,38 David Rajan,39 Abhay Narvekar,40 Sachin Tapasvi,41 Dinshaw Pardiwala,42 Ranjit Panigrahi,43,44 S. Arumugam,45 Vikash Kapoor,46 Bharat Mody,47 Jitender Maheshwari,48 Vivek Dahiya,49 Clement Joseph,50 Mukesh Laddha,51 and Ashok Rajgopal52Knee
Purpose
There is a lack of consensus regarding need for Venous Thrombo Embolism (VTE) prophylaxis following arthroscopic knee surgery and open soft tissue knee reconstruction. Clear cut guidelines like ones for trauma surgery and arthroplasty do not exist and the published literature is limited to case reports with a few society guidelines. Given this lack of consensus, we conducted a modified Delphi questionnaire of international experts to provide recommendations on this topic.
Methods
The consensus statements were generated using an anonymised 3 round modified Delphi questionnaire, sent to an international panel of 38 knee surgeons, with an 80% agreement being set as the limit for consensus. The responses were analysed using descriptive statistics with measures like mode, median and box plots. Feedback was provided to all panelists based on responses from the previous rounds to help generate the consensus.
Results
Six consensus statements were generated after the three rounds of Delphi. Patient factors, prolonged surgery duration and family history of thrombogenic events emerged as the main points to be taken into consideration for prophylaxis.
Conclusion
It was established through this study, that there exists a select group of patients undergoing arthroscopic surgery that justify the usage of VTE prophylaxis. The expert responses to most of the questions in different scenarios favoured usage of VTE prophylaxis based on patient factors like advanced age, past history of VTE, smoking, oral contraceptive use etc.
Level of evidence
Level V.
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