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Incidence of Deep Vein Thrombosis and Pulmonary Embolism after Achilles Tendon Rupture

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The use of venous thromboembolism prophylaxis after an Achilles rupture is controversial. The rates of reported deep vein thrombosis (DVT) range from 6.3% to 34%. There is no agreement regarding prophylactic therapy after an Achilles tendon rupture.

Questions/purposes

We determined the overall risk of DVT and pulmonary embolism (PE) after an Achilles tendon rupture and identified potential risk factors including surgery.

Patients and Methods

We retrospectively reviewed a large healthcare management organization database and identified 1172 patients who had Achilles tendon ruptures. None of the patients routinely received anticoagulation. Patients were stratified into surgical versus nonsurgical group, age older than 40 years, history of congestive heart failure, previous history of DVT or PE, and BMI greater than 30. A patient was considered to have symptomatic DVT or PE related to the Achilles tendon rupture if diagnosed within 3 months from the injury or surgery. We used a multivariable analysis to identify risk factors.

Results

The overall rates for DVT and PE after Achilles tendon ruptures were 0.43% and 0.34%, respectively. Age older than 40 years, congestive heart failure, history of DVT or PE, obesity, and whether a patient had surgery did not predict occurrence of DVT or PE.

Conclusion

We found the overall incidence of symptomatic DVT and PE to be low after an Achilles tendon rupture and believe routine use of anticoagulation might be unwarranted.

Level of Evidence

Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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References

  1. Bergqvist D, Lowe G. Venous thromboembolism in patients undergoing laparoscopic and arthroscopic surgery and in leg casts. Arch Intern Med. 2002;162:2173–2176.

    Article  PubMed  Google Scholar 

  2. Di Nisio M, Di Iorio A, Porreca E, Abate M, Ferrante N, Bandinelli S, Guralnik J, Molino-Lova R, Cuccurullo F, Ferrucci L. Obesity, poor muscle strength, and venous thromboembolism in older persons: the InCHIANTI Study. J Gerontol A Biol Sci Med Sci. 2011;66:320–325.

    Article  PubMed  Google Scholar 

  3. Felcher AH, Mularski RA, Mosen DM, Kimes TM, DeLoughery TG, Laxson SE. Incidence and risk factors for venous thromboembolic disease in podiatric surgery. Chest. 2009;135:917–922.

    Article  PubMed  Google Scholar 

  4. Geerts WG, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW; American College of Chest Physicians Evidence-Based Clinical Practic. Chest. 2008;133(6 suppl):381S–453S.

    Article  PubMed  CAS  Google Scholar 

  5. Hanslow SS, Grujic L, Slater HK, Chen D. Thromboembolic disease after foot and ankle surgery. Foot Ankle Int. 2006;27:693–695.

    PubMed  Google Scholar 

  6. Healy B, Beasley R, Weatherall M. Venous thromboembolism following prolonged cast immobilisation for injury to the tendo Achilles. J Bone Joint Surg Br. 2010;92:646–650.

    Article  PubMed  CAS  Google Scholar 

  7. Heit, JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000;160:809–815.

    Article  PubMed  CAS  Google Scholar 

  8. Hofmann AA, Wyatt RB. Fatal pulmonary embolism following tourniquet inflation: a case report. J Bone Joint Surg Am. 1985;67:633–634.

    PubMed  CAS  Google Scholar 

  9. Houshian S, Tscherning T, Riegels-Nielsen P. The epidemiology of Achilles tendon rupture in a Danish county. Injury. 1998;29:651–654.

    Article  PubMed  CAS  Google Scholar 

  10. Howell MD, Geraci JM, Knowlton AA. Congestive heart failure and outpatient risk of venous thromboembolism: a retrospective, case-control study. J Clin Epidemiol. 2001;54:810–816.

    Article  PubMed  CAS  Google Scholar 

  11. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Available at: http://www.cdc.gov/nchs/icd/icd9cm.htm. Accessed October 5, 2011.

  12. Jorgensen PS, Warming T, Hansen K, Paltved C, Vibeke Berg H, Jensen R, Kirchhoff-Jensen R, Kjaer L, Kerbouche N, Leth-Espensen P, Narvestad E, Rasmussen SW, Sloth C, Tørholm C, Wille-Jørgensen P. Low molecular weight heparin (Innohep) as thromboprophylaxis in outpatients with a plaster cast: a venografic [sic] controlled study. Thromb Res. 2002;105:477–480.

    Article  PubMed  CAS  Google Scholar 

  13. Kock HJ, Schmit-Neuerburg KP, Hanke J, Rudofsky G, Hirche H. Thromboprophylaxis with low-molecular-weight heparin in outpatients with plaster-cast immobilisation of the leg. Lancet. 1995;346:459–461.

    Article  PubMed  CAS  Google Scholar 

  14. Kujath P, Spannagel U, Habscheid W. Incidence and prophylaxis of deep venous thrombosis in outpatients with injury of the lower limb. Haemostasis. 1993;23(suppl 1):20–26.

    PubMed  Google Scholar 

  15. Lapidus LJ, Ponzer S, Elvin A, Levander C, Larfars G, Rosfors S, de Bri E. Prolonged thromboprophylaxis with Dalteparin during immobilization after ankle fracture surgery. Acta Orthop. 2007;78:528–535.

    Article  PubMed  Google Scholar 

  16. Lapidus LJ, Rosfors S, Ponzer S, Levander C, Elvin A, Larfars G, de Bri E. Prolonged thromboprophylaxis with dalteparin after surgical treatment of achilles tendon rupture: a randomized, placebo-controlled study. J Orthop Trauma. 2007;21:52–57.

    Article  PubMed  Google Scholar 

  17. Lassen MR, Borris LC, Nakov RL. Use of the low-molecular-weight heparin repivarin to prevent deep vein thrombosis after leg injury requiring immobilization. N Engl J Med. 2002;347:726–730.

    Article  PubMed  CAS  Google Scholar 

  18. Mizel MS, Temple HT, Michelson JD, Alvarez RG, Clanton TO, Frey CC, Gegenheimer AP, Hurwitz SR, Lutter LD, Mankey MG, Mann RA, Miller RA, Richardson EG, Schon LC, Thompson FM, Yodlowski ML. Thromboembolism after foot and ankle surgery: a multicenter study. Clin Orthop Relat Res. 1998;348:180–185.

    Article  PubMed  Google Scholar 

  19. Nilsson-Helander K, Thurin A, Karlsson J, Erisson BI. High incidence of deep venous thrombosis after Achilles tendon rupture: a prospective study. Knee Surg Sports Traumatol Arthrosc. 2009;17:1234–1238.

    Article  PubMed  Google Scholar 

  20. Patil S, Gandhi J, Curzon I, Hui ACW. Incidence of deep vein thrombosis in patients with fractures of the ankle treated in a plaster cast. J Bone Joint Surg Br. 2007;89:1340–1343.

    Article  PubMed  CAS  Google Scholar 

  21. Samama MM. An epidemiologic study of risk factors for deep vein thrombosis in medical outpatients: the Sirius study. Arch Intern Med. 2000;160:3415–3420.

    Article  PubMed  CAS  Google Scholar 

  22. Solis G, Saxby T. Incidence of DVT following surgery of the foot and ankle. Foot Ankle Int. 2002;23:411–414.

    PubMed  Google Scholar 

  23. SooHoo NF, Krenek L, Eagan MJ, Gurbani B, Ko CY, Zingmond DS. Complication rates following open reduction and internal fixation of ankle fractures. J Bone Joint Surg Am. 2009;91:1042–1049.

    Article  PubMed  Google Scholar 

  24. Wukich DK, Waters DH. Thromboembolism following foot and ankle surgery: a case series and literature review. J Foot Ankle Surg. 2008;47:243–249.

    Article  PubMed  Google Scholar 

  25. Wysowski DK, Nourjah P, Swartz L. Bleeding complications with warfarin use: a prevalent adverse effect resulting in regulatory action. Arch Intern Med. 2007;167:1414–1419.

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Christianne Joy Lane PhD (Biostatistician, University of Southern California) for assistance with the statistical analysis. Her participation in this publication was supported by NIH/NCRR SC-CTSI Grant Number UL1 RR031986. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, 1520 San Pablo St Suite 2000, Los Angeles, CA, 90033, USA

    Arush Patel MD, Timothy Charlton MD & David Thordarson MD

  2. Kaiser Permanente, South Bay, Harbor City, CA, USA

    Brent Ogawa MD

  3. Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Brent Ogawa MD

Authors
  1. Arush Patel MD
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  2. Brent Ogawa MD
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  3. Timothy Charlton MD
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  4. David Thordarson MD
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Corresponding author

Correspondence to David Thordarson MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This study was performed at Kaiser Permanente, South Bay.

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Patel, A., Ogawa, B., Charlton, T. et al. Incidence of Deep Vein Thrombosis and Pulmonary Embolism after Achilles Tendon Rupture. Clin Orthop Relat Res 470, 270–274 (2012). https://doi.org/10.1007/s11999-011-2166-6

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  • DOI: https://doi.org/10.1007/s11999-011-2166-6

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