title: Effect of Chemical Thromboprophylaxis on the Rate of Venous Thromboembolism After Treatment of Foot and Ankle Fractures.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is a well-documented complication in patients with lower limb fractures, but management guidelines for its prevention in isolated foot and ankle fracture patients are conflicting. The aim of this study was to conduct a multicenter, prospective cohort study to define the prevalence of VTE in patients with isolated foot and ankle fractures and determine whether routine prophylaxis is necessary in these patients.
  
  
  METHODS
  In a double-blind, placebo-controlled study, consecutive patients in 3 hospitals who met our criteria were enrolled. After randomization, patients received either thromboprophylaxis with low-molecular-weight heparin units (LMWH group) or placebo (placebo group) for a period of 2 weeks. All patients underwent routine ultrasonography 1 day preoperatively, 1 week postoperatively, and 1 month postoperatively. Demographic parameters were then collected and compared.
  
  
  RESULTS
  Of the 814 patients who met our criteria, 19 patients (2.3%, 95% confidence interval [CI], 0%-31.9%) were found to have objectively confirmed VTE, but none of the patients were symptomatic. Of the 411 patients in the LMWH group, 2 developed VTEs preoperatively and 4 postoperatively; of the 403 patients in the placebo group, 5 developed VTEs preoperatively and 8 postoperatively. The overall incidence of asymptomatic postoperative deep vein thrombosis (DVT) was 0.98% (95% CI 0%-20.3%) in the LMWH group and 2.01% (95% CI 0%-29.5%) in the placebo group without significant difference. Advanced age (odds ratio [OR] 1.050, 95% CI 1.014-1.088, P = .007) and high body mass index (OR 1.201, 95% CI 1.034-1.395, P = .016) were identified as risk factors in predicting occurrence of DVT. No fatal pulmonary emboli or major bleeding complication occurred in either group.
  
  
  CONCLUSIONS
  Routine anticoagulant prophylaxis was not found to be necessary for patients with foot and ankle fractures, although further investigation with a properly powered study design is required to definitively determine which foot and ankle patients are best served by anticoagulation and which ones are not.
  
  
  METHODS
  Level II, prospective comparative study.
authors: Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.|Department of Orthopaedics, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
authors: Xin
authors: X
authors: Zheng
authors: Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
authors: Dong-Ya
authors: DY
authors: Li
authors: Department of Orthopaedics, The Central Hospital of Xuzhou City, Xuzhou, China.
authors: Yufan
authors: Y
authors: Wangyang
authors: Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
authors: Xing-Chen
authors: XC
authors: Zhang
authors: Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
authors: Kai-Jin
authors: KJ
authors: Guo
authors: Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
authors: Feng-Chao
authors: FC
authors: Zhao
authors: Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China.
authors: Yong
authors: Y
authors: Pang
authors: Department of Orthopaedics, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China chenyixin11d@163.com.
authors: Yi-Xin
authors: YX
authors: Chen
mesh_terms: D064386:Ankle Fractures / Q000503:physiopathology*; D000925:Anticoagulants / Q000627:therapeutic use*; D004311:Double-Blind Method; D005528:Foot; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D011446:Prospective Studies; D054556:Venous Thromboembolism / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: ankle; foot; prophylaxis; thromboembolism