[Deep vein thrombosis and thromboembolism in arthroscopic surgery].
Thromboembolic events that occur after routine arthroscopic surgery comprise a complication which may carry lethal consequences. The occurrence of this complication after arthroscopic surgery raises the question as to whether prophylactic anticoagulation should be instituted in these procedures. This review aimed to verify, by a literature search, if routine antithrombotic prophylaxis is justified in arthroscopic surgery. With this in mind, the literature concerning arthroscopic surgery, deep vein thrombosis (DVT) and thrombo-embolism was searched using the available literature concerning these fields, and reviewing the computerized literature database in these fields dating back 30 years. Our review shows that clinically significant thromboembolic events are extremely rare in arthroscopic surgery and may occur in between 1:2000 to 1:5000 cases. Incidence of DVT is higher, detected in prospective studies using venography or Doppler ultrasound in 0.6% to 18%, while the majority of the literature quotes an occurrence of 5% to 10%. Retrospective studies, based on clinically evident DVT, show an incidence of about 1:1000. Approximately 1:10 of DVT cases occur in the proximal venous tree, comprising a potential source for thromboembolic events. Anticoagulants entail certain complications, with an incidence of up to 8%, a far higher incidence than the risk of clinically evident thromboembolic events.


CONCLUSIONS
The occurrence of a clinically apparent thromboembolic event in arthroscopic surgery is extremely rare and probably does not justify the risk of prophylactic antithrombotic medication. As a rule, patients should be instructed for early mobilization as the sole preventive method. If evident risk factors are present: old age, obesity, congestive heart failure (CHF), malignancy, varicose veins, past vein surgery or chronic lower limb swelling--prophylactic treatment should be considered. In such cases certain authorities would recommend administration of aspirin alone. In patients who suffered previous thromboembolic events, further prophylactic measures should be instituted, inclusive of antithrombotic agents as practiced in other orthopaedic procedures.
Mann
Gideon
G
Department of Orthopaedic Surgery, Meir Medical Centre, Kfar Saba. drmann@regin-med.co.il
Hetsroni
Iftach
I
Mei-Dan
Omer
O
Shabat
Shai
S
Barchilon
Vidal
V
Mann
Ayala
A
Nyska
Meir
M
D001182:Arthroscopy / Q000009:adverse effects*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology*; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology*
D005343:Fibrinolytic Agents