Background: Current recommendations on thromboprophylaxis for foot and ankle (FA) surgery are often inconsistent and generally based on weak evidence.
Aims: The aim of this international survey study was to evaluate the current practice and rationale among orthopaedic surgeons regarding VTE prophylaxis following FA surgery.
Methods: From February 2019 to March 2020, a 12-item online questionnaire was sent by e-mail to orthopaedic societies across the world. The questionnaire was hosted by the ISTH RedCAP platform. Topics of interest were VTE rate, prescription, duration and type of thromboprophylaxis, bleeding complications, VTE risk factors, guidelines, risk assessment models and screening of VTE.
Results: A total of 693 FA orthopaedic surgeons from all continents completed the survey of whom 392 (57%) performed >200 FA procedures per year. More than half of respondents (403, 58%) reported that 1-5 patients experienced a symptomatic VTE in the postoperative year. In case thromboprophylaxis was prescribed, aspirin (325, 47%), LMWH (291, 42%) and DOACs (216, 31%) were the preferred choice. The use of aspirin was more common in North America compared to the rest of the world (Figure 1). In Europe, LMWH was predominantly prescribed (Figure 1). Half of surgeons prescribed thromboprophylaxis for the duration of immobilization. Previous DVT, immobility, obesity and inherited thrombophilia were considered the main risk factors indicative of thromboprophylaxis.
Conclusions: Administration, duration and type of thromboprophylaxis differs greatly between FA surgeons and there is a strong intercontinental discrepancy. Although not recommended by the guidelines, orthopaedic surgeons are more likely to use thromboprophylaxis in FA surgery in case of previous DVT, immobility, obesity and inherited thrombophilia. Uniform guidelines are needed to optimize prophylactic strategies in FA procedures.
To cite this abstract in AMA style:Zambelli R, Frolke S, Nemeth B, Baumfeld D, Nery C, Ortiz C, Cannegieter S, Rezende S. VTE Prophylaxis in Foot and Ankle Surgery: A Worldwide Survey [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/vte-prophylaxis-in-foot-and-ankle-surgery-a-worldwide-survey/. Accessed November 29, 2023.
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