title: Deep-vein thrombosis prophylaxis in foot and ankle surgery: what is the current state of practice?
abstract: BACKGROUND
  When contemplating thromboprophylaxis for patients undergoing elective foot and ankle surgery the potential for complications secondary to venous thromboembolism (VTE) must be balanced against the cost, risk, and effectiveness of prophylactic treatment. The incidence of pulmonary embolism (PE) following foot and ankle surgery is considerably lower than after hip or knee surgery. The purpose of this study was to assess current trends in practice regarding VTE prophylaxis among expert orthopaedic foot and ankle surgeons.
  
  
  METHODS
  An e-mail-based survey of active AOFAS (American Orthopaedic Foot and Ankle Society) committee members was conducted (n = 100). Surgeons were questioned as to their use, type, and duration of thromboprophylaxis following elective ankle fusion surgery. Scenarios included the following: (1) A 50-year-old woman with no risk factors; (2) a 50-year-old woman with a history of PE; and (3) a 35-year-old woman actively using birth control pills (BCPs).
  
  
  RESULTS
  The response rate for the survey was 80% (80/100). Replies regarding the use of thromboprophylaxis were as follows: (1) in the absence of risk factors, 57% of respondents (45/80) answered, "No prophylaxis required"; (2) for the scenario in which the patient had experienced a previous PE, 97.5% of respondents (78/80) answered, "Yes" to prophylaxis use; (3) for the scenario in which the patient was on BCP, 61.3% of respondents (49/80) stated that they would give some type of thromboprophylaxis. The most commonly recommended methods of prophylaxis were aspirin, 49% (24/49), and low-molecular-weight heparin, 47% (23/49). The recommended length of time for thromboprophylaxis varied widely, from 1 day to more than 6 weeks.
  
  
  CONCLUSIONS
  . There remains wide variation in the practice of deep-vein thrombosis thromboprophylaxis within the foot and ankle community. Because risks for foot and ankle patients differ from those in the well-studied areas of hip and knee, specific guidelines are needed for foot and ankle surgery.
  
  
  METHODS
  Level V: Expert Opinion.
authors.affiliation: Department of Orthopaedics, Golden Jubilee Hospital Glasgow, Clydebank, UK (KS)Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore (GT)Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada (AY)St Mary's Medical Center, San Francisco, CA (SJP).
authors.forename: Kalpesh
authors.initials: K
authors.lastname: Shah
authors.affiliation: Department of Orthopaedics, Golden Jubilee Hospital Glasgow, Clydebank, UK (KS)Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore (GT)Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada (AY)St Mary's Medical Center, San Francisco, CA (SJP).
authors.forename: Gowreeson
authors.initials: G
authors.lastname: Thevendran
authors.affiliation: Department of Orthopaedics, Golden Jubilee Hospital Glasgow, Clydebank, UK (KS)Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore (GT)Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada (AY)St Mary's Medical Center, San Francisco, CA (SJP).
authors.forename: Alastair
authors.initials: A
authors.lastname: Younger
authors.affiliation: Department of Orthopaedics, Golden Jubilee Hospital Glasgow, Clydebank, UK (KS)Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore (GT)Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada (AY)St Mary's Medical Center, San Francisco, CA (SJP) footsf@gmail.com.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Pinney
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000601:surgery; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D033023:Foot Joints / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents
keywords: ankle; aspirin; deep-vein thrombosis (DVT); foot; foot and ankle surgery; heparin; prophylaxis; pulmonary embolism; thromboembolism; thromboprophylaxis; warfarin