Incidence of Deep Venous Thrombosis Associated With Proximal Hamstring Rupture

Abstract

Background: Rates of deep venous thrombosis (DVT) have been studied for most common orthopaedic injuries. However, rates and risk factors have not been published for proximal hamstring injuries. Purpose: To determine the incidence of symptomatic DVT associated with proximal hamstring rupture and associations with prophylactic anticoagulation. Study Design: Case series; Level of evidence, 4. Methods: Inclusion criteria included all complete and, in a separate cohort, partial proximal hamstring ruptures treated by the senior author from 2007 through 2018 with at least 8 weeks of follow-up. Tendinopathy without tear was excluded. No DVT screening was performed. Charts of patients with symptomatic DVT were reviewed for the treatment method, the presence of imaging-confirmed DVT or pulmonary embolism, and risk factors for DVT. No patients received postinjury DVT prophylaxis. Surgical patients were routinely instructed to take aspirin (325 mg bid) or apixaban (2.5 mg bid) for 4 weeks. Patients with risk factors for DVT received enoxaparin (40 mg daily) for 2 weeks followed by aspirin (325 mg bid) for 2 weeks. Results: A total of 144 complete proximal hamstring ruptures were included: 132 treated operatively and 12 treated nonoperatively. There were 10 DVTs associated with the injury, for an overall rate of 6.9%. Five of the DVTs were diagnosed preoperatively in patients who had not received DVT prophylaxis; the other 5 were diagnosed postoperatively in patients on DVT prophylaxis. Six of the 10 DVTs had identifiable risk factors. All patients with postoperatively diagnosed DVTs were on prophylactic aspirin or enoxaparin. In the partial proximal hamstring rupture cohort of 114 ruptures, there were no DVTs. Conclusion: There is a high incidence of DVT associated with complete proximal hamstring ruptures (6.9%) despite many patients receiving DVT prophylaxis. This is substantially higher than that in other lower extremity injuries. Clinicians should have a high index of suspicion for DVT after these injuries, and postinjury DVT prophylaxis may be warranted.

Incidence of Symptomatic Venous Thromboembolism in Proximal Hamstring Repair: A Prospective Cohort Study

“…That said, there was no further information regarding this patient. Their VTE rate was 2.4%, which while better than Engler et al, 13 remained higher than that reported in our study.…”

“…Engler et al 13 reported a 6.9% incidence in their retrospective case series of 144 complete proximal hamstring ruptures, with 10 patients developing symptomatic DVTs, of which 5 were diagnosed preoperatively and 5 postoperatively. In the postoperative cohort, patients were prescribed either aspirin 325 mg twice daily or Enoxaparin 40 mg once daily.…”

“…All symptomatic VTEs identified in our study occurred in patients in the first protocol, with no symptomatic VTEs occurring in patients receiving aspirin. Engler et al, 13 in their study, used Apixaban, which is a more expensive and irreversible anticoagulant, with higher bleeding risk. We suggest that the routine use of aspirin is an adequate choice of prophylaxis in low-risk individuals, as shown in our series and as widely used in others.…”

“…Studies have reported an incidence as low as 0.68% to as high as 6.9%, but with inconsistent reporting and low patient numbers, further studies would benefit the literature. 8,13,21 The aims of this study were to report the incidence of symptomatic VTE after repair of proximal hamstring avulsion repair and assess the efficacy of our thromboprophylaxis protocol. We hypothesized that the incidence of symptomatic VTE after proximal hamstring avulsion repair is lower than previously reported and that aspirin may be used as an effective form of thromboprophylaxis.…”

“…Studies have reported an incidence as low as 0.68% to as high as 6.9%, but with inconsistent reporting and low patient numbers, further studies would benefit the literature. 8 , 13 , 21 …”