Efficacy and Safety of Low-molecular-weight Heparin After Knee Arthroscopy: A Meta-analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2018 Jun 22

PMID 29927930

Citations 11

Authors

Hai-Feng Huang

Jia-Liang Tian

Xian-Teng Yang

Li Sun

Ru-Yin Hu

Zhi-Hui Yan

Shan-Shan Li

Quan Xie

Xiao-Bin Tian

Affiliations

Soon will be listed here.

Abstract

Background: Venous thromboembolism (VTE) is considered a potentially serious complication of knee arthroscopy and leads to conditions such as deep venous thrombosis (DVT) and pulmonary embolism (PE). Low-molecular-weight heparin (LMWH) is widely employed in knee arthroscopy to reduce perioperative thromboembolic complications. However, the efficacy and safety of LMWH in knee arthroscopy remains unclear.

Methods: Seven randomized controlled clinical trials on LMWH in knee arthroscopy were identified and included in this meta-analysis. The main outcomes of the effectiveness (prevention of DVT and PE) and complications (death, major bleeding, and minor bleeding) of LMWH in knee arthroscopic surgery were assessed using Review Manager 5.3 software.

Results: The meta-analysis indicated that LMWH prophylaxis comprised 79% of asymptomatic DVT. No association was found in symptomatic VTE (RR: 0.90; 95% confidence interval [CI]: 0.39-2.08; P = 0.80), symptomatic DVT (RR: 0.79; 95% CI: 0.28-2.23; P = 0.66), symptomatic PE (RR: 1.36; 95% CI: 0.37-4.97; P = 0.64) and major bleeding (RR: 0.70; 95% CI: 0.12-3.95; P = 0.68) risk during LMWH prophylaxis were identified. Death was not reported in these studies. Moreover, there was a lower incidence of minor bleeding (RR: 0.64; 95% CI: 0.49 to 0.83; P = 0.001) in the control group than in the LMWH group.

Conclusion: Compared with the control group, the group treated with LMWH after knee arthroscopy was no association in reducing the symptomatic VTE rate, symptomatic DVT rate or symptomatic PE rate. The symptomatic VTE rate was 0.5% (11/2,166) in the LMWH group versus 0.6% (10/1,713) in the control group. Although the limitations of this meta-analysis cannot be ignored, the results of our study show that LMWH after knee arthroscopy is ineffective. We recommend that LMWH should not be routinely provided for knee arthroscopy.

Trial Registration: ClinicalTrials.gov NCT03164746.

Citing Articles

The efficacy and safety of low-molecular-weight heparin in patients undergoing knee arthroscopic surgery and anterior cruciate ligament reconstruction.

Li H, Huang L, Fu J, Tong Z, Wei W, Teng C Heliyon. 2023; 9(9):e19696.

PMID: 37810025 PMC: 10558934. DOI: 10.1016/j.heliyon.2023.e19696.

Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy.

Perrotta C, Chahla J, Badariotti G, Ramos J Cochrane Database Syst Rev. 2022; 8:CD005259.

PMID: 35993965 PMC: 9394584. DOI: 10.1002/14651858.CD005259.pub5.

Prophylaxis for preventing venous thromboembolism in knee arthroscopy and soft tissue reconstruction: consensus statements from an international panel of experts.

Easwaran R, Khan M, Sancheti P, Shyam A, Bhandari M, Ranawat A Knee Surg Sports Traumatol Arthrosc. 2022; 30(11):3634-3643.

PMID: 35435469 PMC: 9013735. DOI: 10.1007/s00167-022-06973-w.

Thromboprophylaxis after knee arthroscopy does not decrease the risk of deep vein thrombosis: a network meta-analysis.

Lameire D, Khalik H, Phillips M, MacDonald A, Banfield L, de Sa D Knee Surg Sports Traumatol Arthrosc. 2022; 30(7):2364-2376.

PMID: 35112181 DOI: 10.1007/s00167-021-06857-5.

Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study.

Nagashima M, Takeshima K, Origuchi N, Sasaki R, Okada Y, Otani T Orthop J Sports Med. 2021; 9(12):23259671211056677.

PMID: 34901291 PMC: 8655454. DOI: 10.1177/23259671211056677.

References

. Collaborative overview of randomised trials of antiplatelet therapy--III: Reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients. Antiplatelet Trialists' Collaboration. BMJ. 1994; 308(6923):235-46. PMC: 2539330. View

. Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet. 2000; 355(9212):1295-302. View

Fecher K, Ewald W, Furst A, Hohmann V, Bramlage P . [Prophylaxis of thromboembolic events in surgery. DVT prophylaxis: a comparison of out-patient and hospitalized patients]. Unfallchirurg. 2011; 116(3):246-54. DOI: 10.1007/s00113-011-2094-7. View

Galanaud J, Sevestre M, Genty C, Kahn S, Pernod G, Rolland C . Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis. J Thromb Haemost. 2014; 12(4):436-43. DOI: 10.1111/jth.12512. View

Ellis J, Mulligan I, Rowe J, Sackett D . Inpatient general medicine is evidence based. A-Team, Nuffield Department of Clinical Medicine. Lancet. 1995; 346(8972):407-10. View

Ramos J, Perrotta C, Badariotti G, Berenstein G . Interventions for preventing venous thromboembolism in adults undergoing knee arthroscopy. Cochrane Database Syst Rev. 2008; (4):CD005259. DOI: 10.1002/14651858.CD005259.pub3. View

Chapelle C, Rosencher N, Zufferey P, Mismetti P, Cucherat M, Laporte S . Prevention of venous thromboembolic events with low-molecular-weight heparin in the non-major orthopaedic setting: meta-analysis of randomized controlled trials. Arthroscopy. 2014; 30(8):987-96. DOI: 10.1016/j.arthro.2014.03.009. View

Palareti G, Cosmi B, Lessiani G, Rodorigo G, Guazzaloca G, Brusi C . Evolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: the blind, prospective CALTHRO study. Thromb Haemost. 2010; 104(5):1063-70. DOI: 10.1160/TH10-06-0351. View

Garry J, Duke A, Labropoulos N . Systematic review of the complications following isolated calf deep vein thrombosis. Br J Surg. 2016; 103(7):789-96. DOI: 10.1002/bjs.10152. View

10.

Barco S, Corti M, Trinchero A, Picchi C, Ambaglio C, Konstantinides S . Survival and recurrent venous thromboembolism in patients with first proximal or isolated distal deep vein thrombosis and no pulmonary embolism. J Thromb Haemost. 2017; 15(7):1436-1442. DOI: 10.1111/jth.13713. View

11.

Righini M, Galanaud J, Guenneguez H, Brisot D, Diard A, Faisse P . Anticoagulant therapy for symptomatic calf deep vein thrombosis (CACTUS): a randomised, double-blind, placebo-controlled trial. Lancet Haematol. 2016; 3(12):e556-e562. DOI: 10.1016/S2352-3026(16)30131-4. View

12.

Camporese G, Bernardi E, Prandoni P, Noventa F, Verlato F, Simioni P . Low-molecular-weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial. Ann Intern Med. 2008; 149(2):73-82. DOI: 10.7326/0003-4819-149-2-200807150-00003. View

13.

Wirth T, Schneider B, Misselwitz F, Lomb M, Tuylu H, Egbring R . Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (reviparin): Results of a randomized controlled trial. Arthroscopy. 2001; 17(4):393-9. DOI: 10.1053/jars.2001.21247. View

14.

Murphy R, Heyworth B, Kramer D, Naqvi M, Miller P, Yen Y . Symptomatic Venous Thromboembolism After Adolescent Knee Arthroscopy. J Pediatr Orthop. 2019; 39(3):125-129. DOI: 10.1097/BPO.0000000000000894. View

15.

. Thrombosis: a major contributor to the global disease burden. J Thromb Haemost. 2014; 12(10):1580-90. DOI: 10.1111/jth.12698. View

16.

Marlovits S, Striessnig G, Schuster R, Stocker R, Luxl M, Trattnig S . Extended-duration thromboprophylaxis with enoxaparin after arthroscopic surgery of the anterior cruciate ligament: a prospective, randomized, placebo-controlled study. Arthroscopy. 2007; 23(7):696-702. DOI: 10.1016/j.arthro.2007.02.001. View

17.

Michot M, Conen D, Holtz D, Erni D, Zumstein M, Ruflin G . Prevention of deep-vein thrombosis in ambulatory arthroscopic knee surgery: A randomized trial of prophylaxis with low--molecular weight heparin. Arthroscopy. 2002; 18(3):257-63. DOI: 10.1053/jars.2002.30013. View

18.

Spindler K, Kuhn J, Dunn W, Matthews C, Harrell Jr F, Dittus R . Reading and reviewing the orthopaedic literature: a systematic, evidence-based medicine approach. J Am Acad Orthop Surg. 2005; 13(4):220-9. DOI: 10.5435/00124635-200507000-00002. View

19.

van Adrichem R, Nemeth B, Algra A, le Cessie S, Rosendaal F, Schipper I . Thromboprophylaxis after Knee Arthroscopy and Lower-Leg Casting. N Engl J Med. 2016; 376(6):515-525. DOI: 10.1056/NEJMoa1613303. View

20.

Gray E, Mulloy B, Barrowcliffe T . Heparin and low-molecular-weight heparin. Thromb Haemost. 2008; 99(5):807-18. DOI: 10.1160/TH08-01-0032. View