Study questions routine prophylaxis against thromboembolism after fracture below the knee
Fractures below the knee do not warrant routine prophylaxis against venous thromboembolism, concludes a Canadian prospective cohort study presented at the 47th annual meeting of the American
Society of Hematology in Atlanta, Georgia, this week.
Between August 2002 and June 2005, 2,446 consecutive patients with fractures
of the patella, fibula, foot and tibia were followed prospectively for
three months, with thromboprophylaxis not allowed. Education regarding
symptoms of deep vein thrombosis and pulmonary embolism was provided
at study entry.
Presenting the results, Rita Selby, from the University of Toronto, said
that by three months only seven of 1,174 patients (0.6 per cent) sustained
a symptomatic, objectively confirmed venous thromboembolism.
“It is clear from these results that the side effects of thromboprophylaxis,
such as gastrointestinal bleeds, outweigh any benefits and it is unlikely
to be cost effective,” she said.
She added that many centres in Europe offer routine thromboprophylaxis
for fractures below the knee and that the study should make them reconsider
this practice. The study, however, does not have any implications for
thromboprophylaxis after fractures above the knee, where the benefits
outweigh risks.
The National Institute for Health and Clinical Excellence is expected
to publish safety guidance on prophylaxis against venous thromboembolism
in May 2007. |
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