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Insufficient Evidence for Routine Use of Thromboprophylaxis in Ambulatory Patients with an Isolated Lower Leg Injury Requiring Immobilization: Results of a Meta-Analysis

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background:

There are no generally accepted guidelines for the prevention of venous thromboembolism (VTE) in ambulatory patients requiring immobilization after an isolated lower leg injury. Our objective was to evaluate the effectiveness and safety of pharmacological interventions for preventing VTE in these patients.

Study Design:

Meta-analysis of randomized controlled trials.

Materials and Methods:

We searched PubMed/Medline, EMBASE and the Cochrane Central Register of Controlled Trials for trials with random allocation of thromboprophylaxis, notably low molecular weight heparin (LMWH) versus no prophylaxis or placebo, in ambulatory patients with below-knee or lower leg (including the knee joint) immobilization. Outcome was analyzed using MIX to calculate the pooled risk ratio/relative risk (RR) for each outcome, along with its 95% confidence interval (CI).

Results:

The RR of asymptomatic deep vein thrombosis (DVT) was 0.66 (95% CI 0.44; 1.02) for below-knee immobilization and 0.51 (95% CI 0.37; 0.70) for lower leg immobilization. Low molecular weight heparin versus no prophylaxis or placebo was evaluated. The incidence of symptomatic DVT and PE was too low to show any statistically significant difference between thromboprophylaxis and controls in both groups. Although only one adverse bleeding event was considered to bemajor, the RR for any adverse bleeding event was 1.94 (95% CI 1.03; 3.67).

Conclusion:

There is insufficient evidence to warrant routine use of thromboprophylaxis in ambulatory patients with below-knee or lower leg immobilization after an isolated lower leg injury. The incidence of symptomatic VTE is too low to show a relevant clinical benefit from thromboprophylaxis.

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Authors and Affiliations

  1. Department of Surgery, Erasmus Medical Centre, Diakonessenhuis Utrecht, Rotterdam, The Netherlands

    Roderik Metz & Egbert-Jan M. M. Verleisdonk

  2. University Medical Centre Utrecht, Utrecht, The Netherlands

    Geert J. M. G. van der Heijden

  3. Department of Surgery, Erasmus Medical Centre, 2040, 3000 CA, Rotterdam, The Netherlands

    Roderik Metz

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  1. Roderik Metz
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  2. Egbert-Jan M. M. Verleisdonk
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  3. Geert J. M. G. van der Heijden
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Correspondence to Roderik Metz.

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Metz, R., Verleisdonk, EJ.M.M. & van der Heijden, G.J.M.G. Insufficient Evidence for Routine Use of Thromboprophylaxis in Ambulatory Patients with an Isolated Lower Leg Injury Requiring Immobilization: Results of a Meta-Analysis. Eur J Trauma Emerg Surg 35, 169–175 (2009). https://doi.org/10.1007/s00068-008-8015-y

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  • DOI: https://doi.org/10.1007/s00068-008-8015-y

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