THROMBOPROPHYLAXIS IN FOOT AND ANKLE SURGERY

Abstract

Introduction: In April 2007, NICE published guidance on reducing the risk of venous thromboembolism. Immobilization of a limb in plaster was identified as a risk factor for thromboembolism. NICE recommend that all orthopaedic patients with risk factors are offered low molecular weight heparin (LMWH) whilst an inpatient. There was no cost effective evidence to continue treatment as an outpatient in foot and ankle patients. Foot and ankle surgery often requires prolonged periods of immobilization postoperatively. This study aims to provide a snapshot of current practice amongst foot and ankle surgeons in the UK, highlighting any differences between current practice and NICE guidelines.

Materials and Methods: A random sample of the 267 members of the British Foot and Ankle Surgery Society listed in the 2007 BOA Handbook was obtained. In order to have a 90% confidence level, the sample size was calculated to be 71. The specialist teams identified were contacted by telephone and questioned on their use of thromboprophylaxis for elective patients in plaster. The results were collated and compared to NICE guidelines.

Results: 94% of foot and ankle surgeons prescribe LMWH to post operative elective inpatients in plaster. 65% of specialists continue thromboprophylaxis for out-patients. The duration and agent of thromboprophylaxis varied markedly. The commonest agents were LMWH and aspirin. The length of treatment ranged from ten days to the duration of plaster immobilization.

Discussion: The results highlight a trend amongst foot and ankle surgeons to exceed current NICE guidelines for thromboprophylaxis, continuing treatment for an extended outpatient period. Although there was shown to be no cost effective evidence to continue treatment, the practice continues.

Conclusion: The vast majority of UK foot and ankle surgeons fulfill the NICE recommendations on thromboprophylaxis. There is a clear need for a policy statement from BOFAS on the extended use of thromboprophylaxis for outpatients immobilized in plaster.