Rates of Deep Venous Thrombosis and Pulmonary Embolus After Anterior Cruciate Ligament Reconstruction

Erickson, Brandon J.; Saltzman, Bryan M.; Campbell, Kirk A.; Fillingham, Yale A.; Harris, Joshua D.; Gupta, Anil K.; Bach, Bernard R.

doi:10.1177/1941738115576927

Cited by 30 publications

(24 citation statements)

References 32 publications

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“…The incidence of PE was 0.1%. These findings are similar to the conclusions by Erickson et al[ 3 ]. They described an 8.4% rate of DVT after ACL reconstructions in patients without postoperative thromboprophylaxis (73% was asymptomatic), while the rate of symptomatic PE was 0.2%[ 3 ].…”

Section: Discussionsupporting

confidence: 93%

“…These findings are similar to the conclusions by Erickson et al[ 3 ]. They described an 8.4% rate of DVT after ACL reconstructions in patients without postoperative thromboprophylaxis (73% was asymptomatic), while the rate of symptomatic PE was 0.2%[ 3 ]. Maletis et al[ 11 ] described symptomatic DVT in 0.2% of 16192 primary and revision ACL surgeries.…”

Section: Discussionsupporting

confidence: 93%

“…Venous thromboembolism (VTE) after ACL reconstruction may present clinically as symptomatic or asymptomatic deep venous thrombosis (DVT), pulmonary embolism (PE) and postthrombotic syndrome[ 1 - 3 ]. The incidence of VTE after ACL reconstruction varies from 0.2%-14%[ 1 , 2 , 4 - 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review

Janssen¹,

Reijman²,

Janssen³

et al. 2016

WJO

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AIMTo summarize the current knowledge on vascular complications and deep venous thrombosis (DVT) prophylaxis after anterior cruciate ligament (ACL) reconstruction.METHODSA systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. MEDLINE, EMBASE, Cochrane, Web of Science, CINAHL, PubMed publisher, and Google scholar medical literature databases were searched up to November 10, 2015. Any arthroscopic surgical method of primary or revision intra-articular ACL reconstruction of all graft types in humans was included. A risk of bias assessment was determined.RESULTSFourty-seven studies were included in the review. Pseudaneurysms were the most frequently reported arterial complication after ACL reconstruction, irrespective of graft type or method of graft fixation with an incidence of 0.3%. The time to diagnosis of arterial complications after ACL reconstruction varied from days to mostly weeks but even years. After ACL reconstruction without thromboprophylaxis, the incidence of DVT was 9.7%, of which 2.1% was symptomatic. The incidence of pulmonary embolism was 0.1%. Tourniquet time > 2 h was related to venous thromboembolism. Thromboprophylaxis is indicated in patients with risk factors for venous thromboembolism.CONCLUSIONAfter ACL reconstruction, the incidence of arterial complications, symptomatic DVT and pulmonary embolism was 0.3%, 2.1% and 0.1% respectively. Arterial complications may occur with all types of arthroscopic ACL reconstruction, methods of graft fixation as well as any type of graft. Patients considered to be at moderate or high risk of venous thromboembolism should routinely receive thromboprophylaxis after ACL reconstruction.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

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Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review

Janssen¹,

Reijman²,

Janssen³

et al. 2016

WJO

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“…Venous thromboembolism (VTE) is a significant perioperative risk with many common orthopaedic procedures. 1 , 5 , 8 , 13 ACL reconstruction carries a risk of developing symptomatic and asymptomatic DVT. A previous systematic review reported the risks of developing asymptomatic DVT, symptomatic DVT, and pulmonary embolism (PE) after ACL reconstruction were 8.4%, 2.3%, and 0.2%, respectively.…”

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confidence: 99%

Deep Venous Thrombosis Prophylaxis in Anterior Cruciate Ligament Reconstructive Surgery: What Is the Current State of Practice?

Keller

Moutzouros

Dines

et al. 2017

Sports Health: A Multidisciplinary Approach

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Background:Venous thromboembolism (VTE) is a significant perioperative risk with many common orthopaedic procedures. Currently, there is no standardized recommendation for the use of VTE prophylaxis during anterior cruciate ligament (ACL) reconstruction. This study sought to evaluate the current prophylactic practices of fellowship-trained sports medicine orthopaedic surgeons in the United States.Hypothesis:Very few surgeons use perioperative VTE prophylaxis for ACL reconstructive surgery.Study Design:Survey.Methods:Surveys were emailed to the alumni networks of 4 large ACGME-accredited sports medicine fellowship programs. Questions were focused on their current use of chemical and nonchemical VTE prophylaxis.Results:Surveys were completed by 142 surgeons in the United States, yielding a response rate of 32%. Of those who responded, 50.7% stated that they routinely use chemical prophylaxis, with 95.5% of those using aspirin (acetylsalicylic acid [ASA]). There was no standardized dosing protocol, with respondents using ASA 325 mg once (46%) or twice daily (26%) or ASA 81 mg once (18%) or twice (10%) daily. The most common reason for not including chemical prophylaxis within the reconstruction procedure was that it is unnecessary given the low risk of VTE. Physicians also based their prophylaxis regimen more on their own clinical experience than concern for litigation.Conclusion:Half of all sports medicine fellowship–trained surgeons surveyed routinely use chemical VTE prophylaxis after ACL reconstruction, with more than 90% of those using ASA. Of those using ASA, there was no prevailing dosing protocol. For those not using chemical prophylaxis, the most important reason was that it was felt to be unnecessary due to the risks outweighing the benefits. Those who do not regularly use chemical prophylaxis would be willing to, however, if a patient had a personal or family history of clotting disorder or is currently on birth control. Additionally, clinical experience was the primary driver for a current prophylaxis protocol.Clinical Relevance:This survey study evaluating the use of VTE prophylaxis with ACL reconstruction lends clinical insight to the current practice of a large, geographically diverse group of fellowship-trained sports medicine orthopaedic surgeons in the United States.

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“…About 30 first-time cases of DVT occur annually for every 100 000 persons in the 25-to 35-year age range. 4 The authors of a recent systematic review 5 found that the rate of DVT development in patients after anterior cruciate ligament (ACL) reconstruction who did not receive postoperative pharmacologic anticoagulation was a somewhat alarming 8.4%, whereas the rate of PE in these patients was 0.2%. Troublingly, 73% of these patients with DVTs were asymptomatic.…”

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confidence: 99%

Posttraumatic Deep Vein Thrombosis in Collegiate Athletes: An Exploration Clinical Case Series

Hummel

Geisler

Reynolds

et al. 2018

Journal of Athletic Training

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Collectively, both cases reinforce the need for the attending clinicians to perform a thorough history and pay attention to subtle clinical findings, regardless of the relatively low risk in college-aged athletes. Although the Wells' CPRs for DVT can be used as a diagnostic guideline in the general population, it might not fully address the risks inherent in a young, otherwise healthy athletic population. We propose a risk-screening tool that is based on and modified from our experiences with these 2 patients and the known prediction rules and positive probability influences.

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Rates of Deep Venous Thrombosis and Pulmonary Embolus After Anterior Cruciate Ligament Reconstruction

Cited by 30 publications

References 32 publications

Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review

Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: A systematic review

Deep Venous Thrombosis Prophylaxis in Anterior Cruciate Ligament Reconstructive Surgery: What Is the Current State of Practice?

Posttraumatic Deep Vein Thrombosis in Collegiate Athletes: An Exploration Clinical Case Series

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