Michael J. Gouzoulis, Peter Y. Joo, Alexander J. Kammien, William M. McLaughlin, Brad Yoo, Jonathan N. Grauer
Abstract
Venous thromboembolism (VTE) is an uncommon, but potentially morbid, complication following foot and ankle fractures. Current standard is to not administer thromboprophylaxis to patients with such injuries. Nonetheless, patient and fracture factors might affect this risk/benefit consideration. The goal of this study was to determine what patients are most at risk.
Introduction
Orthopedic injuries and surgery are well-known to predispose patients to venous thromboembolism (VTE) [1–8], defined as the occurrence of deep vein thrombosis (DVT) and/or pulmonary embolus (PE). VTE thromboprophylaxis may be recommended after injury and surgery if the benefits are thought to outweigh the risks [9, 10]. Nonetheless, the risk/benefit ratio of VTE thromboprophylaxis makes this not typically recommended for isolated foot and ankle fractures.
Methods
Data for the present study were obtained through a retrospective review of the 2015 to 2020 M53 Ortho Pearldiver database. The Pearldiver database is a large national claims database that contains patient information on over 53 million patients in both the inpatient and outpatient setting in the United States. It contains information all patients with both commercial and government (Medicare, Medicaid) insurance, and identifies patients based on billing. The Yale IRB determined that the investigator is not engaged in research involving human subjects. As such, IRB review and approval are not required.
Discussion
VTE is a rare event after isolated foot and ankle fractures, and current guidelines do not recommend routine VTE prophylaxis following related fractures/surgeries. Prevention strategies such as prophylactic anticoagulation is based around identification of patient underlying risk factors, both acquired and inherited, that place one at an increased risk of VTE [22, 30–32]. There remains a paucity of evidence on which patients, and specifically which risk factors, would benefit most from postoperative VTE prophylaxis.
Citation: Gouzoulis MJ, Joo PY, Kammien AJ, McLaughlin WM, Yoo B, Grauer JN (2022) Risk factors for venous thromboembolism following fractures isolated to the foot and ankle fracture. PLoS ONE 17(10): e0276548. https://doi.org/10.1371/journal.pone.0276548
Academic Editor: Yaodong Gu, Ningbo University, CHINA
Received: May 14, 2022; Accepted: October 7, 2022; Published: October 20, 2022
Copyright: © 2022 Gouzoulis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the article and its Supporting Information files.
Funding: The authors received no specific funding for this work.
Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Brad Yoo: Consultant for Depuy Synthes Jonathan N. Grauer: North American Spine Society Journal (NASSJ) editor, and North American Spine Society and Lumbar Spine Research Society boards.
