Should orthopedic outpatients with lower limb casts be given deep vein thrombosis prophylaxis?

This study was undertaken to assess the incidence of symptomatic deep vein thrombosis (DVT) in orthopedic outpatients who are treated with lower limb casts and were not on any DVT prophylaxis.

We retrospectively analyzed the incidence of DVT in a district general hospital over a 1-year period. The names of the patients with proven DVT were cross-checked from the outpatient plaster register to identify those who had lower limb cast treatment and not on any DVT prophylaxis.

There were 381 patients who have had lower limb casts and treated as outpatients. In all, 7 patients developed DVT during the period of cast immobilization as outpatients and of these 4 patients were detected to have an associated pulmonary embolism.

Incidence of DVT among patients with lower limb casts varies. At present, there is no clear guideline on the DVT prophylaxis for those outpatients who are at risk. Our results show that even though the proven DVTs were low, the potential of developing a pulmonary embolism in these patients is high and should be prevented.

Risk stratification could be beneficial to identify high-risk patients. Deep vein thrombosis prophylaxis should be discussed for those orthopedic outpatients who are at high-risk of developing thrombosis during immobilization and treatment with lower limb casts. This article emphasis the need for a uniform national guideline in the management of such patients.