Top

International Orthopaedics

Published in:

01-10-2019 | Original Paper

The effect of anticoagulants on venous thrombosis prevention after knee arthroscopy: a systematic review

Authors: Hai-Feng Huang, Jia-Liang Tian, Li Sun, Xian-Teng Yang, Yu-Kun Shen, Shan-Shan Li, Quan Xie, Xiao-Bin Tian

Published in: International Orthopaedics | Issue 10/2019

Abstract

Purpose

Knee arthroscopy, with its unique advantages, has become a routine surgery and is widely carried out around the world. Venous thromboembolism (VTE) after knee arthroscopy is a potentially serious complication. This article analyzes the effects of anticoagulant therapy after knee arthroscopy.

Methods

We used key words or entry terms without any limitations to search the PubMed, Embase, and Cochrane Library databases. Randomized controlled trials (RCTs) of drug prophylaxis for VTE after knee arthroscopy until November 2017 were included in our review.

Results

This systematic review identified nine RCTs, consisting of 4290 patients, investigating drug prophylaxis in knee arthroscopy. There are three main drugs for preventing thrombosis after arthroscopic knee surgery: low-molecular-weight heparin (LMWH), rivaroxaban, and aspirin. Our study concluded that there is no difference in symptomatic VTE (excluding symptomatic distal DVT) risk during anticoagulant prophylaxis (RR, 0.98; 95% CI, 0.44–2.19; I² value = 0%; P = 0.97). Moreover, there was a lower incidence of symptomatic distal DVT (RR, 0.16; 95% CI, 0.06–0.45; I² value = 0%; P = 0.0005) in the anticoagulant group than in the control group.

Conclusions

In our study, anticoagulant therapy after knee arthroscopy was ineffective. We recommend that anticoagulants not be provided routinely after knee arthroscopy.

Falck-Ytter Y, Francis CW, Johanson NA et al (2012) 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 141:e278S–e325S. https://doi.org/10.1378/chest.11-2404 CrossRefPubMedPubMedCentral

Giuseppini MU, Guiducci S, Bardelli M (2010) Prophylaxis of venous thromboembolism in orthopedic surgery. Minerva Med 101:49–58PubMed

Camporese G, Bernardi E, Noventa F et al (2016) Efficacy of rivaroxaban for thromboprophylaxis after knee arthroscopy (ERIKA). A phase II, multicentre, double-blind, placebo-controlled randomised study. Thromb Haemost 116:349–355. https://doi.org/10.1160/TH16-02-0118 CrossRefPubMed

Ilahi OA, Reddy J, Ahmad I (2005) Deep venous thrombosis after knee arthroscopy: a meta-analysis. Arthroscopy 21:727–730. https://doi.org/10.1016/j.arthro.2005.03.007 CrossRefPubMed

Hinzpeter-Cohen J, Catalán-González J, Zamorano-Cadenas A, Cuzmar-Grimalt D, Escudero-Heldt M (2013) Pulmonary thromboembolism after knee arthroscopy. Case report. Acta Ortop Mex 27:51–54PubMed

Tufano A, Coppola A, Cerbone AM, Ruosi C, Franchini M (2011) Preventing postsurgical venous thromboembolism: pharmacological approaches. Semin Thromb Hemost 37:252–266. https://doi.org/10.1055/s-0031-1273089 CrossRefPubMed

Boos CJ, Hinton A, Lip GY (2005) Ximelagatran: a clinical perspective. Eur J Intern Med 16:267–278. https://doi.org/10.1016/j.ejim.2005.02.005 CrossRefPubMed

Roth VP (1995) Prophylaxis of deepvein thrombosis in outpatients undergoing arthroscopic meniscus operation. Orthop Prax 5:345–348

Wirth T, Schneider B, Misselwitz F, Lomb M, Tüylü H, Egbring R, Griss P (2001) Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (reviparin): results of a randomized controlled trial. Arthroscopy 17:393–399CrossRef

10.

Michot M, Conen D, Holtz D, Erni D, Zumstein MD, Ruflin GB, Renner N (2002) Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery: a randomized trial of prophylaxis with low--molecular weight heparin. Arthroscopy 18:257–263CrossRef

11.

Canata GL, Chiey A (2003) Prevention of venous thromboembolism after ACL reconstruction: a prospective, randomized study. Knee Surgery and Orthopedic Sports. Medicine Congress, Auckland, New Zealand; March 10–13

12.

Marlovits S, Striessnig G, Schuster R, Stocker R, Luxl M, Trattnig S, Vécsei V (2007) Extended-duration thromboprophylaxis with enoxaparin after arthroscopic surgery of the anterior cruciate ligament: a prospective, randomized, placebo-controlled study. Arthroscopy 23:696–702. https://doi.org/10.1016/j.arthro.2007.02.001 CrossRefPubMed

13.

Camporese G, Bernardi E, Prandoni P et al (2008) Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial. Ann Intern Med 149:73–82CrossRef

14.

Kaye ID, Patel DN, Strauss EJ, Alaia MJ, Garofolo G, Martinez A, Jazrawi LM (2015) 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 73:243–248

15.

van Adrichem RA, Nemeth B, Algra A et al (2017) Thromboprophylaxis after knee arthroscopy and lower-leg casting. N Engl J Med 376:515–525. https://doi.org/10.1056/NEJMoa1613303 CrossRefPubMed

16.

Palareti G, Cosmi B, Lessiani G et al (2010) Evolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: the blind, prospective CALTHRO study. Thromb Haemost 104:1063–1070. https://doi.org/10.1160/TH10-06-0351 CrossRefPubMed

17.

Galanaud JP, Sevestre MA, Genty C et al (2014) Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis. J Thromb Haemost 12:436–443. https://doi.org/10.1111/jth.12512 CrossRefPubMed

18.

Barco S, Corti M, Trinchero A et al (2017) Survival and recurrent venous thromboembolism in patients with first proximal or isolated distal deep vein thrombosis and no pulmonary embolism. J Thromb Haemost 15:1436–1442. https://doi.org/10.1111/jth.13713 CrossRefPubMed

19.

Garry J, Duke A, Labropoulos N (2016) Systematic review of the complications following isolated calf deep vein thrombosis. Br J Surg 103:789–796. https://doi.org/10.1002/bjs.10152 CrossRefPubMed

20.

Righini M, Galanaud JP, Guenneguez H et al (2016) Anticoagulant therapy for symptomatic calf deep vein thrombosis (CACTUS): a randomised, double-blind, placebo-controlled trial. Lancet Haematol 3:e556–e562. https://doi.org/10.1016/S2352-3026(16)30131-4 CrossRefPubMed

21.

Chapelle C, Rosencher N, Jacques Zufferey P et al (2014) Prevention of venous thromboembolic events with low-molecular-weight heparin in the non-major orthopaedic setting: meta-analysis of randomized controlled trials. Arthroscopy 30:987–996. https://doi.org/10.1016/j.arthro.2014.03.009 CrossRefPubMed

22.

Rocha E, Imberti D, Paschina E (2007) Low-molecular-weight heparins: before or after surgery? New concepts and evidence: congress report from the Sigma Tau/ROVI Satellite Symposium (Rome, Italy, 13 November 2006). Clin Drug Investig 27:357–366CrossRef

23.

Wuillemin WA, Demarmels Biasiutti F (1998) Ambulatory therapy of acute deep thrombophlebitis. Ther Umsch 55:546–547PubMed

24.

Murphy RF, Heyworth B, Kramer D, Naqvi M, Miller PE, Yen YM, Kocher MS, Shore BJ (2016) Symptomatic venous thromboembolism after adolescent knee arthroscopy. J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000000894 CrossRef

25.

Huang HF, Tian JL, Yang XT et al (2018) Efficacy and safety of low-molecular-weight heparin after knee arthroscopy: a meta-analysis. PLoS One 13:e0197868. https://doi.org/10.1371/journal.pone.0197868 CrossRefPubMedPubMedCentral

26.

Antiplatelet Trialists’ Collaboration (1994) Collaborative overview of randomised trials of antiplatelet therapy--III: reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients. BMJ 308:235–246CrossRef

27.

Pulmonary Embolism Prevention (PEP) Trial Collaborative Group (2000) Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: pulmonary embolism prevention (PEP) trial. Lancet 355:1295–1302CrossRef

28.

Mauck KF, Froehling DA, Daniels PR et al (2013) Incidence of venous thromboembolism after elective knee arthroscopic surgery: a historical cohort study. J Thromb Haemost 11:1279–1286. https://doi.org/10.1111/jth.12283 CrossRefPubMed

29.

Krych AJ, Sousa PL, Morgan JA, Levy BA, Stuart MJ, Dahm DL (2015) Incidence and risk factor analysis of symptomatic venous thromboembolism after knee arthroscopy. Arthroscopy 31:2112–2118. https://doi.org/10.1016/j.arthro.2015.04.091 CrossRefPubMed

30.

Maletis GB, Inacio MC, Reynolds S, Funahashi TT (2012) Incidence of symptomatic venous thromboembolism after elective knee arthroscopy. J Bone Joint Surg Am 94:714–720. https://doi.org/10.2106/JBJS.J.01759 CrossRefPubMed

31.

Lu X, Qian J, Yang B (2017) Efficacy of treatments in patients with symptomatic venous thrombosis after knee arthroscopic surgery. Zhonghua Yi Xue Za Zhi 97:26–28. https://doi.org/10.3760/cma.j.issn.0376-2491.2017.01.007 CrossRefPubMed

32.

Camporese G, Bernardi E, Noventa F (2009) Prevention of deep venous thrombosis after knee arthroscopy. Recent advances. Recenti Prog Med 100:227–232PubMed

33.

Demers C, Marcoux S, Ginsberg JS, Laroche F, Cloutier R, Poulin J (1998) Incidence of venographically proved deep vein thrombosis after knee arthroscopy. Arch Intern Med 158:47–50CrossRef

34.

Delis KT, Hunt N, Strachan RK, Nicolaides AN (2001) Incidence, natural history and risk factors of deep vein thrombosis in elective knee arthroscopy. Thromb Haemost 86:817–821CrossRef

35.

Hetsroni I, Lyman S, Do H, Mann G, Marx RG (2011) Symptomatic pulmonary embolism after outpatient arthroscopic procedures of the knee: the incidence and risk factors in 418,323 arthroscopies. J Bone Joint Surg Br 93:47–51. https://doi.org/10.1302/0301-620X.93B1.25498 CrossRefPubMed

36.

Graham WC, Flanigan DC (2014) Venous thromboembolism following arthroscopic knee surgery: a current concepts review of incidence, prophylaxis, and preoperative risk assessment. Sports Med 44:331–343. https://doi.org/10.1007/s40279-013-0121-2 CrossRefPubMed

37.

Schippinger G, Wirnsberger GH, Obernosterer A, Babinski K (1998) Thromboembolic complications after arthroscopic knee surgery. Incidence and risk factors in 101 patients. Acta Orthop Scand 69:144–146CrossRef

38.

Hoppener MR, Ettema HB, Henny CP, Verheyen CC, Büller HR (2006) Low incidence of deep vein thrombosis after knee arthroscopy without thromboprophylaxis: a prospective cohort study of 335 patients. Acta Orthop 77:767–771. https://doi.org/10.1080/17453670610012962 CrossRefPubMed

39.

Deitelzweig SB, McKean SC, Amin AN, Brotman DJ, Jaffer AK, Spyropoulos AC (2008) Prevention of venous thromboembolism in the orthopedic surgery patient. Cleve Clin J Med 75:S27–S36CrossRef

40.

Vázquez FJ, Lifschitz E, Watman R et al (2013) Venous thromboembolic prophylaxis. Guidelines for adults in Argentina. Medicina (B Aires) 73:1–26

Title: The effect of anticoagulants on venous thrombosis prevention after knee arthroscopy: a systematic review
Authors: Hai-Feng Huang
Jia-Liang Tian
Li Sun
Xian-Teng Yang
Yu-Kun Shen
Shan-Shan Li
Quan Xie
Xiao-Bin Tian
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 10/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-4212-4

At a glance: The STEP trials

Springer Medicine

The effect of anticoagulants on venous thrombosis prevention after knee arthroscopy: a systematic review

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2019

Proximal femoral replacement in non-oncologic patients undergoing revision total hip arthroplasty

Quality of life after staged bilateral total knee arthroplasty: a minimum five-year follow-up study of seventy-eight patients

Customized implants for acetabular Paprosky III defects may be positioned with high accuracy in revision hip arthroplasty

“More accurate correction using “patient-specific” cutting guides in opening wedge distal femur varization osteotomies

Outcomes of acetabular fractures in the elderly: a five year retrospective study of twenty seven patients with primary total hip replacement

Long-term survivorship of a monoblock long cementless stem in revision total hip arthroplasty