High risk of venous thromboembolism after orthopedic surgery in patients with thrombophilia

Pinto, Roberto Zambelli de Almeida; Nemeth, Banne; Touw, Carolina E.; Rosendaal, Frits R.; Rezende, Suely Meireles; Cannegieter, Suzanne C.

doi:10.1111/jth.15163

Cited by 9 publications

(8 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients with Factor V Leiden were nearly twenty-five times increased odds of VTE. Factor V Leiden is commonly cited as greatly increasing risk of venous thromboembolisms and is one of the genetic predispositions that play a role in half of idiopathic VTEs [ 40 ], and has been found to increase VTE risk overall in many orthopaedic indications [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for venous thromboembolism following fractures isolated to the foot and ankle fracture

Gouzoulis

Joo²,

Kammien³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

Objective Venous thromboembolism (VTE) is an uncommon, but potentially morbid, complication following foot and ankle fractures. Current standard is to not administer thromboprophylaxis to patients with such injuries. Nonetheless, patient and fracture factors might affect this risk/benefit consideration. The goal of this study was to determine what patients are most at risk. Methods The M53Ortho Pearldiver database was used to identify patients with fractures isolated to the foot and ankle that were treated non-operatively or operatively. Patients with pilon, other appendicular fractures remote from the foot and ankle, and other traumatic injuries were excluded. The 90-day occurrence of VTE was identified based on codes for deep vein thrombosis or pulmonary embolism. Characteristics of those patients who did and did not have VTEs were compared using chi-square analyses. Multivariate logistical regression was then performed to determined factors independently associated with VTE. Finally, timing of VTE relative to fracture was analyzed. Results A total of 298,886 patients with isolated foot or ankle fractures were identified, of which 1,661 (0.56%) had VTE in the 90 days following fracture. In terms of timing, 27.3% occurred in the first week, and 49.8% occurred in the first three weeks. Independent risk factors for VTE included (in decreasing order):prior VTE (odd ratio [OR] = 25.44), factor V Leiden (OR = 24.34), active cancer (OR = 1.84), specific fracture relative to metatarsal fracture (multiple fractures [OR: 1.51], ankle fracture [OR = 1.51], and calcaneus fracture [OR = 1.24]), surgical treatment (OR = 1.41), male sex (OR = 1.19), greater Elixhauser index (OR = 1.05), and increasing age (OR:1.05 per decade) (p<0.05 for each). Conclusions The present study found that, although only 0.56% of isolated foot and ankle fractures had a VTE within ninety days. Defined risk factors, such as Factor V Leiden, prior VTE, surgical treatment, active cancer, specific fracture patterns, and surgical treatment significantly affected the odds of their occurrence.

show abstract

Section: Discussionmentioning

confidence: 99%

Risk factors for venous thromboembolism following fractures isolated to the foot and ankle fracture

Gouzoulis

Joo²,

Kammien³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…In terms of VTE risk, thromboprophylaxis guidelines stratify orthopaedic procedures in low-, intermediate-, and high-risks groups. All patients with thrombophilia should be classified in the high-risk VTE groups independently from the underlying procedure 1513 .…”

Section: - What Is the Optimal Vte Prophylaxis Modality For Patients ...mentioning

confidence: 99%

“…Performing surgery in a patient with inherited thrombophilia supposes a 13-fold increased risk of VTE within 1 year (odds ratio [OR], 13.3 95% confidence interval [CI]; 7.2 -24.7) 1513 . Furthermore, VTE risk was highest within the first 30days following surgery (OR adj 17.5; 95% CI, 9.2 -33.4) and remained high up to 90-days postoperatively in this population [1513][1514][1515][1516][1517][1518] .…”

Section: Marc Carrier Alex C Spyropoulosmentioning

confidence: 99%

“…This reflects the requirement for several thrombotic risk factors or high-risk situations to be present, for a clinical event to occur in patients with inherited thrombophilia 1512 , such as surgery. Performing surgery in a patient with inherited thrombophilia supposes a 13-fold increased risk of VTE within 1 year (odds ratio [OR], 13.3 95% confidence interval [CI]; 7.2 -24.7) 1513 . Furthermore, VTE risk was highest within the first 30days following surgery (OR adj 17.5; 95% CI, 9.2 -33.4) and remained high up to 90-days postoperatively in this population [1513][1514][1515][1516][1517][1518] .…”

Section: Marc Carrier Alex C Spyropoulosmentioning

confidence: 99%

See 1 more Smart Citation

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

show abstract

“…41 Only recently, in a large population-based case–control study, elevated FVIII levels were associated with a high risk of VTE after orthopaedic surgery (OR, 18.6; 95% CI, 7.4–46.9), comparable to the risk associated with the presence of FVL (OR, 17.5, 95% CI, 4.1–73.6). 42 Despite solid evidence for an association between elevated FVIII levels and VTE, it is still a matter of debate whether or not FVIII should be included into thrombophilia screening. The widespread use of one-stage clotting assays with their analytical shortcomings (mainly overestimating FVIII levels), the large intra-individual variation, the potential influence of a previous thrombotic event, any acute phase reaction, any underlying disease such as cancer, and the lack of a defined cut-off value make the use of FVIII as a thrombophilia factor problematic.…”

Section: Introductionmentioning

confidence: 99%

Markers of Hereditary Thrombophilia with Unclear Significance

2022

View full text Add to dashboard Cite

Thrombophilia leads to an increased risk of venous thromboembolism. Widely accepted risk factors for thrombophilia comprise deficiencies of protein C, protein S, and antithrombin, as well as the factor V “Leiden” mutation, the prothrombin G20210A mutation, dysfibrinogenemia, and, albeit less conclusive, increased levels of factor VIII. Besides these established markers of thrombophilia, risk factors of unclear significance have been described in the literature. These inherited risk factors include deficiencies or loss-of-activity of the activity of ADAMTS13, heparin cofactor II, plasminogen, tissue factor pathway inhibitor (TFPI), thrombomodulin, protein Z (PZ), as well as PZ-dependent protease inhibitor. On the other hand, thrombophilia has been linked to the gain-of-activity, or elevated levels, of α2-antiplasmin, angiotensin-converting enzyme, coagulation factors IX (FIX) and XI (FXI), fibrinogen, homocysteine, lipoprotein(a), plasminogen activator inhibitor-1 (PAI-1), and thrombin-activatable fibrinolysis inhibitor (TAFI). With respect to the molecular interactions that may influence the thrombotic risk, more complex mechanisms have been described for endothelial protein C receptor (EPCR) and factor XIII (FXIII) Val34Leu. With focus on the risk for venous thrombosis, the present review aims to give an overview on the current knowledge on the significance of the aforementioned markers for thrombophilia screening. According to the current knowledge, there appears to be weak evidence for a potential impact of EPCR, FIX, FXI, FXIII Val34Leu, fibrinogen, homocysteine, PAI-1, PZ, TAFI, and TFPI on the thrombotic risk.

show abstract

High risk of venous thromboembolism after orthopedic surgery in patients with thrombophilia

Cited by 9 publications

References 30 publications

Risk factors for venous thromboembolism following fractures isolated to the foot and ankle fracture

Risk factors for venous thromboembolism following fractures isolated to the foot and ankle fracture

Recommendations from the ICM-VTE: General

Markers of Hereditary Thrombophilia with Unclear Significance

Contact Info

Product

Resources

About