Pharmacological Thromboprophylaxis Effectiveness in Low-Risk Patients Underwent Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial
-
Mohammadreza Minator Sajjadi
,
Mohammad Nazarinasab
,
Amirali Behroozi
,
Amin Karimi
,
Amir Mehrvar
,
Seyed Amir Ahmad Safavi Naini
Abstract
Background: There is a paucity of evidence and controversies regarding prophylaxis strategies in low-risk patients undergoing knee arthroscopy. This study aims to evaluate the effectiveness and safety of aspirin and low-molecular-weight heparin (LMWH) in an arthroscopic anterior cruciate ligament (ACL) reconstruction for low-risk patients.
Methods: We performed a preoperational evaluation a week before surgery for any sign of pulmonary embolism (PE) and deep vein thrombosis (DVT). For this purpose, we used single limited compression Doppler ultrasonography (CUS) of the lower extremities. Rehabilitation started before the time of the surgery to improve the range of motion (ROM) and quadriceps muscle function. A team of 3 orthopedists performed the procedures. The same surgical technique and graft were used with spinal anesthesia, and operation time was recorded.
Results: The mean age of participants was 31.4 ± 5.6 years, with 93 individuals (67%) being men and 23% women. No cases of DVT or PE were observed. Three cases in the LMWH group and one case in the aspirin group experienced minor surgical site bleeding. One case of hemarthrosis with normal ultrasonography occurred in the LMWH group. Regarding safety and effectiveness, there was no statistically significant difference between the parallel arms.
Conclusion: The use of LMWH or aspirin after simple arthroscopic ACL reconstruction in low-risk patients showed no difference in effectiveness. Hence, the routine use of thromboprophylaxis in this setting is questionable although adverse events are rare.
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13. Mokhtari M, Salameh P, Kouchek M, Kashani BS, Taher A, Waked M. The AVAIL ME Extension: A multinational Middle Eastern survey of venous thromboembolism risk and prophylaxis. J Thromb Haemost. 2011;9(7):1340-9. doi: 10.1111/j.1538-7836.2011.04336.x. [PubMed: 21605327].
14. Sturgill LP, Snyder-Mackler L, Manal TJ, Axe MJ. Interrater reliability of a clinical scale to assess knee joint effusion. J Orthop Sports Phys Ther. 2009;39(12):845-9. doi: 10.2519/jospt.2009.3143. [PubMed: 20032559].
15. Zhu J, Jiang H, Marshall B, Li J, Tang X. Low-molecular-weight heparin for the prevention of venous thromboembolism in patients undergoing knee arthroscopic surgery and anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials. Am J Sports Med. 2019;47(8): 1994-2002. doi: 10.1177/0363546518782705. [PubMed: 30113231].
16.Huang HF, Tian JL, Yang XT, Sun L, Hu RY, Yan ZH, et al. Efficacy and safety of low-molecular-weight heparin after knee arthroscopy: A meta-analysis. PLoS One. 2018;13(6):e0197868. doi: 10.1371/journal.pone.0197868. [PubMed: 29927930]. [PubMed Central: PMC6013230].
17. Zheng G, Tang Q, Shang P, Pan XY, Liu HX. No effectiveness of anticoagulants for thromboprophylaxis after non-major knee arthroscopy: A systemic review and meta-analysis of randomized controlled trials. J Thromb Thrombolysis. 2018;45(4):562-70. doi: 10.1007/s11239-018-1638-x. [PubMed: 29549559].
18. Kaye ID, Patel DN, Strauss EJ, Alaia MJ, Garofolo G, Martinez A, et al. Prevention of venous thromboembolism after arthroscopic knee surgery in a low-risk population with the use of aspirin. A Randomized Trial. Bull Hosp Jt Dis (2013). 2015;73(4):243-8. [PubMed: 26630467].
19. Kassai B, Boissel JP, Cucherat M, Sonie S, Shah NR, Leizorovicz A. A systematic review of the accuracy of ultrasound in the diagnosis of deep venous thrombosis in asymptomatic patients. Thromb Haemost. 2004;91(4):655-66. doi: 10.1160/TH03-11-0722. [PubMed: 15045125]. [PubMed Central: PMC2706694].
2. Barrera OF, Sikka RS, Wolters B, Graver R, Boyd JL, Nelson B, et al. Autograft versus allograft: An economic cost comparison of anterior cruciate ligament reconstruction. Arthroscopy. 2011;27(9):1219-25.
doi:10.1016/j.arthro.2011.04.008. [PubMed:21820267].
3. Salzler MJ, Lin A, Miller CD, Herold S, Irrgang JJ, Harner CD.
Complications after arthroscopic knee surgery. Am J Sports Med. 2014;42(2):292-6. doi: 10.1177/0363546513510677. [PubMed: 24284049].
4. Mohammad Reza MS, Reza Z, Mohammad AO, Pooyan J, Mohammad RM. Comparing the effectiveness of intra- articular injection of bupivacaine, dexmedetomidine Vs. 0.9% saline on pain control after arthroscopic anterior cruciate ligament reconstruction. J Orthop Spine Trauma. 2020;4(2): 23-5. doi: 10.18502/jost.v4i2.2957.
5. Flevas DA, Megaloikonomos PD, Dimopoulos L, Mitsiokapa E, Koulouvaris P, Mavrogenis AF. Thromboembolism prophylaxis in orthopaedics: An update. EFORT Open Rev. 2018;3(4):136-48. doi: 10.1302/2058-5241.3.170018. [PubMed: 29780621]. [PubMed Central: PMC5941651].
6. Sharif-Kashani B, Mohebi-Nejad A, Abooturabi SM. Estimated prevalence of venous thromboembolism in Iran: Prophylaxis still an unmet challenge. Tanaffos. 2015;14(1):27-33. doi:tanaffos-14-27 [pii]. Retrieved from. [PubMed: 26221149]. [PubMed Central: PMC4515327].
7. Pisoudeh K, Mortazavi SJ, Shahriar Kamrani R, Seyyedhosseinzadeh SH, Abolghasemian M. Prophylaxis of venous thromboembolism in orthopedic trauma patients: A review. J Orthoped Spine Trauma. 2017;3(3):e58053. doi: 10.5812/jost.58053.
8. Erickson BJ, Saltzman BM, Campbell KA, Fillingham YA, Harris JD, Gupta AK, et al. Rates of deep venous thrombosis and pulmonary embolus after anterior cruciate ligament reconstruction: A systematic review. Sports Health. 2015;7(3):261-6. doi: 10.1177/1941738115576927. [PubMed: 26131305]. [PubMed Central: PMC4482304].
9. Gali JC, Camargo DB. Thromboprophylaxis for total knee arthroplasty. Rev Bras Ortop (Sao Paulo). 2019;54(1):1-5. doi: 10.1016/j.rbo.2017.06.025. [PubMed: 31363235]. [PubMed Central: PMC6415521].
10. Jacobs JJ, Mont MA, Bozic KJ, Della Valle CJ, Goodman SB, Lewis CG, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty. J Bone Joint Surg Am. 2012;94(8):746-7. doi: 10.2106/JBJS.9408.ebo746. [PubMed: 22517391]. [PubMed Central: PMC3326685].
11. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e278S-e325S. doi: 10.1378/chest.11-2404. [PubMed: 22315265]. [PubMed Central: PMC3278063].
12. Keller RA, Moutzouros V, Dines JS, Bush-Joseph CA, Limpisvasti O. Deep venous thrombosis prophylaxis in anterior cruciate ligament reconstructive surgery: what is the current state of practice? Sports Health. 2018;10(2):156-9. doi: 10.1177/1941738117730576. [PubMed: 28927346]. [PubMed Central: PMC5857726].
13. Mokhtari M, Salameh P, Kouchek M, Kashani BS, Taher A, Waked M. The AVAIL ME Extension: A multinational Middle Eastern survey of venous thromboembolism risk and prophylaxis. J Thromb Haemost. 2011;9(7):1340-9. doi: 10.1111/j.1538-7836.2011.04336.x. [PubMed: 21605327].
14. Sturgill LP, Snyder-Mackler L, Manal TJ, Axe MJ. Interrater reliability of a clinical scale to assess knee joint effusion. J Orthop Sports Phys Ther. 2009;39(12):845-9. doi: 10.2519/jospt.2009.3143. [PubMed: 20032559].
15. Zhu J, Jiang H, Marshall B, Li J, Tang X. Low-molecular-weight heparin for the prevention of venous thromboembolism in patients undergoing knee arthroscopic surgery and anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials. Am J Sports Med. 2019;47(8): 1994-2002. doi: 10.1177/0363546518782705. [PubMed: 30113231].
16.Huang HF, Tian JL, Yang XT, Sun L, Hu RY, Yan ZH, et al. Efficacy and safety of low-molecular-weight heparin after knee arthroscopy: A meta-analysis. PLoS One. 2018;13(6):e0197868. doi: 10.1371/journal.pone.0197868. [PubMed: 29927930]. [PubMed Central: PMC6013230].
17. Zheng G, Tang Q, Shang P, Pan XY, Liu HX. No effectiveness of anticoagulants for thromboprophylaxis after non-major knee arthroscopy: A systemic review and meta-analysis of randomized controlled trials. J Thromb Thrombolysis. 2018;45(4):562-70. doi: 10.1007/s11239-018-1638-x. [PubMed: 29549559].
18. Kaye ID, Patel DN, Strauss EJ, Alaia MJ, Garofolo G, Martinez A, et al. Prevention of venous thromboembolism after arthroscopic knee surgery in a low-risk population with the use of aspirin. A Randomized Trial. Bull Hosp Jt Dis (2013). 2015;73(4):243-8. [PubMed: 26630467].
19. Kassai B, Boissel JP, Cucherat M, Sonie S, Shah NR, Leizorovicz A. A systematic review of the accuracy of ultrasound in the diagnosis of deep venous thrombosis in asymptomatic patients. Thromb Haemost. 2004;91(4):655-66. doi: 10.1160/TH03-11-0722. [PubMed: 15045125]. [PubMed Central: PMC2706694].
| Files | ||
| Issue | Vol 10 No 3 (2024) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v10i3.16779 | |
| Keywords | ||
| Knee Venous Thrombosis Arthroscopy Low-Molecular-Weight Heparin Aspirin Randomized Controlled Trial | ||
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How to Cite
1.
Minator Sajjadi M, Nazarinasab M, Behroozi A, Karimi A, Mehrvar A, Safavi Naini SAA. Pharmacological Thromboprophylaxis Effectiveness in Low-Risk Patients Underwent Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial. J Orthop Spine Trauma. 2024;10(3):101-4.
