title: Thromboembolism After Intramedullary Nailing for Metastatic Bone Lesions.
abstract: BACKGROUND
  The risk of venous thromboembolism (VTE) in patients undergoing intramedullary nailing for skeletal metastatic disease is currently undefined. The purpose of our study was to determine the risk of thromboembolic events, to define the risk factors for VTE, and to define the rate of wound complications in this population.
  
  
  METHODS
  A retrospective review of surgical databases at three National Cancer Institute (NCI)-designated cancer centers identified 287 patients with a total of 336 impending or pathologic long-bone fractures that were stabilized with intramedullary nailing between February 2001 and April 2013. Statistical analysis was performed utilizing multivariable logistic regression and Fisher exact tests.
  
  
  RESULTS
  The overall rate of VTE was twenty-four (7.1%) of the 336; thirteen (3.9%) were pulmonary embolism (PE), and eleven (3.3%), deep venous thrombosis (DVT). In two patients, adequate anticoagulation data were not available. We found no significant relationship between the type of anticoagulant used and VTE. There was a significant positive correlation found between lung-cancer histology and the development of VTE (p < 0.001) or PE (p < 0.001). The absence of radiation therapy approached significance (p = 0.06) with respect to decreased overall VTE risk. Wound complications were documented for 11 (3.3%) of the operations.
  
  
  CONCLUSIONS
  There is a high rate of VTE among those with skeletal metastatic disease who undergo intramedullary nailing, even while receiving postoperative thromboembolic prophylaxis. Current anticoagulation protocols may be inadequate. Wound-complication risk with anticoagulant use in this population is low and should not be a deterrent to adequate anticoagulant use for this population.
authors.affiliation: Jefferson Medical College, 925 Chestnut Street, Philadelphia, PA 19107. E-mail address for B. Shallop: brandon.shallop@jefferson.edu. E-mail address for A. Starks: alexandriaostarks@gmail.com.
authors.forename: Brandon
authors.initials: B
authors.lastname: Shallop
authors.affiliation: Jefferson Medical College, 925 Chestnut Street, Philadelphia, PA 19107. E-mail address for B. Shallop: brandon.shallop@jefferson.edu. E-mail address for A. Starks: alexandriaostarks@gmail.com.
authors.forename: Alexandria
authors.initials: A
authors.lastname: Starks
authors.affiliation: Albert Einstein Medical College, 1300 Morris Park Avenue, Bronx, NY 10461. E-mail address: simon.greenbaum@med.einstein.yu.edu.
authors.forename: Simon
authors.initials: S
authors.lastname: Greenbaum
authors.affiliation: Montefiore Medical Center, 111 East 210th Street, New York, NY 10467. E-mail address: DGELLER@montefiore.org.
authors.forename: David S
authors.initials: DS
authors.lastname: Geller
authors.affiliation: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for A. Lee: alee29@partners.org. E-mail address for J. Ready: JREADY@partners.org.
authors.forename: Alan
authors.initials: A
authors.lastname: Lee
authors.affiliation: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for A. Lee: alee29@partners.org. E-mail address for J. Ready: JREADY@partners.org.
authors.forename: John
authors.initials: J
authors.lastname: Ready
authors.affiliation: Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA 19107. E-mail address: geno.merli@jefferson.edu.
authors.forename: Geno
authors.initials: G
authors.lastname: Merli
authors.affiliation: Rothman Institute, Thomas Jefferson University, 125 South 9th Street, Suite 1000, Philadelphia, PA 19107. E-mail address: mitchell.maltenfort@rothmaninstitute.com.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.affiliation: Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107. Email address: John.Abraham@rothmaninstitute.com.
authors.forename: John A
authors.initials: JA
authors.lastname: Abraham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000150:complications* / Q000556:secondary / Q000601:surgery; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000379:methods; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054547:National Cancer Institute (U.S.); D011379:Prognosis; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality
chemical_list: D000925:Anticoagulants