Venous thromboembolism in major lower limb orthopedic surgery

Kumar, Sudhir

doi:10.4103/0019-5413.108870

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…In general, surgical management of bone sarcoma requires more extensive resections and reconstructions, leading to longer surgical duration and increased endothelial injury. In addition, the majority of bone sarcomas occur in the lower extremities, 27 which is associated with a higher risk of DVT 28 . To compound the surgical insult, there is often reduced postoperative mobility following bone sarcoma surgery, further amplifying the risk of VTE.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism rates in patients with bone and soft tissue sarcoma of the extremities following surgical resection: A systematic review

Krzyzaniak

You

Mosca

et al. 2021

Journal of Surgical Oncology

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Background: Patients undergoing an orthopedic surgery for bone or soft tissue sarcoma are at increased venous thromboembolism (VTE) risk. Unfortunately, there is a lack of thromboprophylaxis guidelines in this population. The purpose of this systematic review was to determine the soft tissue and bone sarcoma VTE rate and to explore the thromboprophylaxis regimens used.Methods: The databases MEDLINE, EMBASE, and CENTRAL were queried using keywords related to VTE and long bone malignancy requiring surgical intervention to 2020. Included studied reported VTE rate in patients with surgically managed extremity sarcoma. Descriptive statistics and weighted mean totals were calculated.Results: A total of 2082 studies were screened and 23 studies were included. The overall VTE rate was 2.9%, with a rate of 3.7% and 1.4% in patients with bone and soft tissue sarcomas, respectively. Low-molecular-weight heparin was the most commonly used chemoprophylaxis.Conclusions: There is a high VTE rate following sarcoma surgery. The VTE rate is higher in bone sarcoma surgery, which may be attributed to differences in surgery and postoperative recovery. There was no consensus on the duration or type of thromboprophylaxis used. Future research is needed to determine the most effective thromboprophylaxis regimen in patients with sarcoma and whether individualized thromboprophylaxis is required.

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Section: Discussionmentioning

confidence: 99%

Venous thromboembolism rates in patients with bone and soft tissue sarcoma of the extremities following surgical resection: A systematic review

Krzyzaniak

You

Mosca

et al. 2021

Journal of Surgical Oncology

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“…Moreover, approximately 4.7% of patients who undergo major orthopedic interventions without prophylaxis experience symptomatic VTE [ 8 ]. The incidence of fatal PE in patients using thromboprophylaxis has reduced from 3-7% to 0.1% in 90 days after surgery [ 9 ]. The pathophysiology behind these procedures that makes the patients prone to VTE relies on several factors such as manipulating the extremity, the use of a tourniquet, immobilization, and the use of polymethylmethacrylate (PMMA) cement [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Thromboprophylaxis Post-Orthopedic Surgery

Alsheikh¹,

Hilabi²,

Aleid³

et al. 2021

Cureus

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Given the high risk of venous thromboembolism (VTE) post-orthopedic surgery and the vital role of thromboprophylaxis in preventing VTEs, this meta-analysis aimed to assess the efficacy of thromboprophylaxis post major orthopedic surgery and the relevant safety measures. In this review, we conducted a computer-aided search of Google Scholar, PubMed, CINAHL, Cochrane, Medline, and EMBASE databases. We included all published randomized clinical trials (RCTs) that utilized enoxaparin, fondaparinux, dabigatran, rivaroxaban, apixaban, and aspirin for VTE prophylaxis in patients undergoing total hip arthroplasty (THA), hip fracture surgery, and total knee arthroplasty (TKA) based on primary and secondary outcomes. The Cochrane Collaboration tool was used to evaluate the risk of bias. All statistical analyses were performed using Review Manager Software. A total of 23 RCTs were included with a total sample of 48,424 patients and an overall low risk of bias. The efficacy of enoxaparin in preventing VTEs in the TKA group was significantly better than fondaparinux. In the THA group, the efficacy of enoxaparin was significantly better than apixaban. The efficacies of fondaparinux, dabigatran, rivaroxaban, apixaban, and aspirin were comparable to that of enoxaparin in reducing VTE-associated mortality, major bleeding, and adverse events. In conclusion, we found that all included drugs were non-inferior to enoxaparin in VTE-associated mortality, major bleeding, and adverse events.

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“…Scarcity of Indian studies on VTE and Thromboprophylaxis compels us to use the data, which is based on Western population. Very few studies are available on Indian patients with VTE and using Thromboprophylaxis [10] . Velu Nair [11] et al in their retrospective study of 795 patients undergoing major orthopedic surgery given short term prophylaxis with 7-11 days has shown an incidence of DVT to be 3.27% with prophylaxis.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of enoxaparin as athromboprophylactic agent in major lower limb orthopaedic surgeries

Reddy¹,

Kamal²,

Gadigar³

et al. 2019

Int. J. Orthop. Sci.

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Venous Thromboembolism (VTE) which consists of Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE) is a potentially fatal & common complication following major lower limb orthopaedic surgeries like Hip, Knee Arthroplasty & Hip fracture surgeries which fall under highest risk category for VTE stratification. Analysis of selected Indian articles show that rates of DVT with prophylaxis is 8% and without prophylaxis 14%. Therefore VTE prophylaxis is essential to prevent the mortality and morbidity associated with it. Low Molecular weight heparins like Enoxaparin is one of the leading anticoagulants registered for use worldwide and has a long track record of over several years for safety and efficiency in orthopaedic surgeries. 180 patients undergoing Surgeries for fracture around Hip, Femur fracture surgery, patients undergoing Hip and Knee Arthroplasty were given prophylaxis for DVT in the form of Inj. Enoxaparin 40 Mg S/C once a day for 10 days starting 12 hours after epidural catheter removal. Three Bilateral lower limb venous Doppler scans were done in all the patients, one at the time of admission, one on eleventh post op day and another on thirtieth post-operative day to look for development or progression of deep vein thrombosis. Only One Patient (0.55%) showed ultrasonographic evidence of proximal asymptomatic Deep Vein Thrombosis on the eleventh post-operative day. Patient was treated for the same and the thrombus resolved while on treatment as shown by repeat Doppler scan done on twentieth day following detection. No cases of Fatal Pulmonary embolism or major complications were noted in the study. Enoxaparin is a safe and effective thromboprophylactic agent when used for the duration of 10 days post operatively in Major lower Limb orthopaedic Surgeries.

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Venous thromboembolism in major lower limb orthopedic surgery

Cited by 3 publications

References 13 publications

Venous thromboembolism rates in patients with bone and soft tissue sarcoma of the extremities following surgical resection: A systematic review

Venous thromboembolism rates in patients with bone and soft tissue sarcoma of the extremities following surgical resection: A systematic review

Efficacy and Safety of Thromboprophylaxis Post-Orthopedic Surgery

Efficacy of enoxaparin as athromboprophylactic agent in major lower limb orthopaedic surgeries

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