Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-limb immobilization

Zee, Aniek Ag; Lieshout, Kelly van; Heide, Martin van der; Janssen, Loes; Janzing, H

doi:10.1002/14651858.cd006681.pub4

Cited by 105 publications

(102 citation statements)

References 65 publications

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“…Moreover, the observation that the risk of DVT increased by 7% per each increasing year of age, is confirmed by earlier studies [1,11,20]. The finding also indicates that older age together with BMI should be considered while deciding DVT preventive interventions during leg immobilization [11,20,22]. This is the first prospective randomized study to study DVT rate during EFM.…”

Section: Discussionsupporting

confidence: 77%

“…The finding that patients with BMI over 26 exhibited an almost threefold increased odds for sustaining a DVT at 2 weeks was supported by the literature and may reflect that specific interventions should be initiated for obese patients [20,22]. Moreover, the observation that the risk of DVT increased by 7% per each increasing year of age, is confirmed by earlier studies [1,11,20].…”

Section: Discussionsupporting

confidence: 69%

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Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture: a randomized controlled trial

Aufwerber

Heijne

Edman

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose The hypothesis was that early functional mobilization would reduce the incidence of deep venous thrombosis (DVT) during leg immobilization after Achilles tendon rupture surgery. A secondary aim was to evaluate if the amount of weightbearing and daily steps influenced the risk of sustaining a DVT. Methods One-hundred and fifty patients with Achilles tendon rupture repair were randomized to treatment with early functional mobilization, encouraging full weightbearing and ankle motion in orthosis, or treatment-as-usual, i.e., 2 weeks of unloading in plaster cast followed by 4 weeks weightbearing in orthosis. At 2 and 6 weeks postoperatively, all patients were screened for DVT using compression duplex ultrasound. During the first 2 weeks postoperatively, patient-reported loading, pain and step counts were assessed. Results At 2 weeks, 28/96 (29%) of the patients in early functional mobilization group and 15/49 (31%) in the control group (n.s) had sustained a DVT. At 6 weeks, the DVT rate was 35/94 (37%) in the early functional mobilization and 14/49 (29%) in the control group (n.s). During the first postoperative week, the early functional mobilization group reported low loading and higher experience of pain vs. the control group (p = 0.001). Low patient-reported loading ≤ 50% (OR = 4.3; 95% CI 1.28-14.3) was found to be an independent risk factor for DVT, in addition to high BMI and higher age. Conclusions Early functional mobilization does not prevent the high incidence of DVT during leg immobilization in patients with Achilles tendon rupture as compared to treatment-as-usual. The low efficacy of early functional mobilization is mainly explained by postoperative pain and subsequent low weightbearing. To minimize the risk of DVT, patients should be encouraged to load at least 50% of body weight on the injured leg 1 week after surgery.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 69%

Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture: a randomized controlled trial

Aufwerber

Heijne

Edman

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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“…To what degree do symptoms need to change to suggest a risk of symptomatic VTE to both the patient and clinician? Both these issues are perhaps reflected in the highly variable incidence of VTE across the included studies, ranging from 1.8% to 40.4% . We present our outcomes in this study stratified by symptomatic disease and anatomical location of VTE to address these issues.…”

Section: Discussionmentioning

confidence: 99%

Pharmacological thromboprophylaxis to prevent venous thromboembolism in patients with temporary lower limb immobilization after injury: systematic review and network meta‐analysis

Horner

Stevens

Pandor

et al. 2020

Journal of Thrombosis and Haemostasis

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Background: Thromboprophylaxis has the potential to reduce venous thromboembolism (VTE) following lower limb immobilization resulting from injury. Objectives:We aimed to estimate the effectiveness of thromboprophylaxis, compare different agents, and identify any factors associated with effectiveness. Methods:We undertook a systematic review and network meta-analysis (NMA) of randomized trials reporting VTE or bleeding outcomes that compared thromboprophylactic agents with each other or to no pharmacological prophylaxis, for this indication. An NMA was undertaken for each outcome or agent used, and a series of study-level network meta-regressions examined whether population characteristics, type of injury, treatment of injury, or duration of thromboprophylaxis were associated with treatment effect. Results: Data from 6857 participants across 13 randomized trials showed that, compared with no treatment, low molecular weight heparin (LMWH) reduced the risk of any VTE (odds ratio [OR]: 0.52; 95% credible interval [CrI]: 0.37-0.71), clinically detected deep vein thrombosis (DVT) (OR: 0.39; 95% CrI: 0.12-0.94) and pulmonary embolism (PE) (OR: 0.16; 95% CrI: 0.01-0.74), whereas fondaparinux reduced the risk of any VTE (OR: 0.13; 95% CrI: 0.05-0.30) and clinically detected DVT (OR: 0.10; 95% CrI: 0.01-0.86), with inconclusive results for PE (OR: 0.40; 95% CrI: 0.01-7.53).Conclusions: Thromboprophylaxis with either fondaparinux or LMWH appears to reduce the odds of both asymptomatic and clinically detected VTE in people with temporary lower limb immobilization following an injury. Treatment effects vary by outcome and are not always conclusive. We were unable to identify any treatment effect modifiers other than thromboprophylactic agent used.

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“…The risk lingers for up to 2-3 months after surgery despite using TPX, and joint risk of death within 3 months is as high as 13% [5]. Research has shown that 4.8-40% of trauma patients who did not use TPX, developed DVT symptoms [12]. This is the reason why appropriate thromboprophylaxis in that sort of trauma is crucial, and all patients with femoral fractures should take TPX.…”

Section: Thromboprophylaxis In Particular Types Of Traumasmentioning

confidence: 99%

“…According to ACCP recommendations from 2012, prophylaxis should be applied earlier than 12 hours before surgery and 12 hours after surgery at the earliest; this is very important in acute traumas and demands for immediate surgery. Prophylaxis should last for a minimum of 10-14 days [12].…”

Section: Thromboprophylaxis In Particular Types Of Traumasmentioning

confidence: 99%

Advances in thromboprophylaxis in trauma patients, based on current guidelines and research

Grodzicki¹,

Flis²,

Sławiński³

et al. 2018

Med Og Nauk Zdr.

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Introduction. Thromboprophylaxis remains a significant element in the operative and non-operative treatment of trauma patients due to high risk of thromboembolic incidents. This problem concerns a major part of trauma patients. Objective. The aim of the study is to review and evaluate the efficacy of the pharmacological and non-pharmacological methods of venous thromboembolic (VTE) prophylaxis. Brief state of knowledge. There are a few pharmacological methods of VTE prevention, such as: unfractionated heparin (UFH), low molecular weight heparin (LMWH), vitamin K antagonists (VKA), factor Xa inhibitors and direct thrombin Inhibitor. There are also a couple of non-pharmacological methods: intermittent pneumatic compression and graduated compression stockings. The choice of method should be guided by the type of trauma, patient's health status, and potential contraindications for other methods of prophylaxis. Methods. The authors analyzed recent guidelines and research using the most up-to-date sources. The types of traumas were categorized, and a summary compiled of the best way of VTE prophylaxis for each type of trauma. Recommended methods were also rated with the risk of VTE and haemorrhage. Conclusions. The conclusions show that there are still too few studies and the guidelines extant are unambiguous (ambiguous?). Improvment must be sought for in thromboprophylaxis and toward defining uniform guidelines. Due to the large number of surgeries in the treatment of traumas, there is a need to retain all the guidelines in one article. Every operation is connected with high risk of venous thromboembolism, therefore optimal prophylaxis is crucial.

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Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-limb immobilization

Cited by 105 publications

References 65 publications

Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture: a randomized controlled trial

Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture: a randomized controlled trial

Pharmacological thromboprophylaxis to prevent venous thromboembolism in patients with temporary lower limb immobilization after injury: systematic review and network meta‐analysis

Advances in thromboprophylaxis in trauma patients, based on current guidelines and research

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