Prolonged Thromboprophylaxis With Dalteparin After Surgical Treatment of Achilles Tendon Rupture: A Randomized, Placebo-Controlled Study

Abstract

DVT is common after surgical treatment of Achilles tendon rupture, and therefore effective thromboprophylaxis is desirable. In our study, thromboprophylaxis with dalteparin, however, does not affect the incidence of DVT during immobilization after Achilles tendon rupture surgery. Long-term effects of immobilization, such as the risk for postthrombotic syndrome, need to be investigated further.

Incidence of Deep Vein Thrombosis and Pulmonary Embolism after Achilles Tendon Rupture

“…Although there is general consensus regarding the use of prophylactic antithrombotic therapy after hip and knee surgery [4], there is no agreement regarding prophylactic therapy after Achilles tendon rupture. Lapidus et al [16] performed a randomized, placebo-controlled study of 91 patients with surgically treated Achilles tendon ruptures and found no beneficial effect of thromboprophylaxis with dalteparin in preventing DVT. The use of anticoagulation medications is not without side effects.…”

The benefit of pharmacological venous thromboprophylaxis in foot and ankle surgery

“…[35] Lapidus et al, [36] however, found a 28% DVT rate in patients after ankle fracture surgery who did not receive pharmacological prophylaxis. In two studies following Achilles tendon rupture repair, the incidences of DVT were 36% [19] and 6%. [26] In a more recent prospective study, we found an 8.5% incidence of VTE in patients who required immobilisation in a below-knee cast and non-weightbearing for ≥4 weeks after foot and ankle surgery.…”

“…[6,[8][9][10][11][12][13][14][15][16][17][18][19][20]26,37,41] A difficulty of long-term follow-up of patients is that many DVT events occur several weeks or longer after discharge. [37,42] …”

Insufficient Evidence for Routine Use of Thromboprophylaxis in Ambulatory Patients with an Isolated Lower Leg Injury Requiring Immobilization: Results of a Meta-Analysis

“…Five trials met our search criteria [4,[12][13][14][15]. All five trials compared thromboprophylaxis by low molecular weight heparin to no prophylaxis or placebo.…”