Symptomatic Deep Vein Thrombosis Following Elective Knee Arthroscopy Over the Age of 40

Abstract

Thromboprophylaxis following arthroscopic knee surgery (AKS) is not clear in the literature. The purpose of this study was to present the incidence of symptomatic deep vein thrombosis (DVT) following elective AKS over the age of 40. The secondary purpose was to investigate risk factors associated with venous thromboembolic events (VTEs). Surgical database and outpatient clinic follow-up charts of the patients who underwent AKS for any reason were included in the study. Odds for risk factors such as previous medical history of thrombosis, any family history for clotting disorders, diabetes mellitus (DM), oral contraceptive usage, body mass index, history of malignancy, and smoking were evaluated. The incidence of DVT following AKS significantly increased in the patients older than 40 years who had a previous medical history of VTE, DM, and smoking. A variety of guidelines exist for VTE prophylaxis; however, one should focus on risk factors related to the patient’s medical history and current medical conditions. In this study, smoking, DM, and previous history of DVT increased DVT risk significantly, and thromboprophylaxis should be kept in mind for these patients.

Clinical Risk Factors and Perioperative Hematological Characteristics of Early Postoperative Symptomatic Deep Vein Thrombosis in Posterior Lumbar Spinal Surgery

“…No statistical difference was observed between groups, in terms of smoking and alcohol intake, in the present study, despite the historical evidence supporting the positive correlation between smoking and postoperative DVT risks. 22,26 In the present study, predominant patients with a positive tobacco or alcohol use history were male (smoking [M:F] 336:9; drinking [M:F] 231:16). The univariate analysis on male tobacco and male alcohol users revealed that a higher proportion of symptomatic DVT patients reported a smoking history, when compared with male controls (P ¼ 0.008), favoring the conclusion that smoking can be a risk factor in postoperative DVT.…”

Recommendations from the ICM-VTE: Trauma

“…Knowledge of Virchow's triad (hypercoagulability, endothelial injury and venous stasis) and the mechanisms of production of thromboembolic disease, can help guide thromboprophylaxis in individual situations where there is no specific evidence 351 . Hardware removal could be stratified as complicated or not with respect to the difficulty of removal, surgical time, bony manipulation, use of tourniquet, and need for general anesthesia.…”

Incidence and Prevention of Thromboembolic Complications for Sports and Arthroscopic-related Surgery: Evidence-based Recommendations

“…The authors found that a tourniquet time of > 2 hours increased the incidence of DVT from 12.1% to 17.4%, and the extended time was associated with a combined ACL reconstruction and concomitant procedures. 13 In a recent study by Özcan et al, 14 the authors studied the incidence of DVT in patients above the age of 40 compared with patients under 40 years of age in patients undergoing knee arthroscopy. A total of 1385 patients were included in the study (610 patients > 40 y of age), and the overall instance of VTE was 0.79% (n = 11).…”

“…The authors recommended that thromboprophylaxis be considered for these at-risk patients, noting the importance of understanding the risk factors as they specifically relate to the patient, their medical history, and their current medical conditions when determining thromboprophylaxis use. 14 In the adolescent population, future research is necessary to determine the risks and necessity of thromboprophylaxis. Murphy et al 16 found that all adolescent patients that developed a VTE postoperatively had at least 1 risk factor; however, given the lack of high-level evidence, the authors recommended that early mobilization, when possible, is a feasible prevention technique and to only consider the lowest risk forms of thromboprophylaxis (eg, short-term aspirin) for older adolescents (above 15 y).…”

“…In contrast, body mass index, oral contraceptive use, and female sex were not found to increase the risk of DVT. 14 Two separate studies performed in 2019 reported incidence rates of VTE after knee arthroscopy in the adolescent and pediatric sports medicine population. 15,16 Among 746 patients with an average age of 15.2, Lau et al 15 reported an incidence rate of 0.27% (2/746) with confirmed diagnoses of 1 DVT and 1 PE of 5 patients originally suspected to have VTE.…”