Oral thromboprophylaxis in patients with ankle fractures immobilized in a below the knee cast

Lower-limb immobilization has been implicated as an etiologic factor for a venous thromboembolism (VTE). Most of the current literature encourages the use of thromboprophylaxis with injectable low-molecular-weight heparin (LMWH) in trauma patients. Injectable anticoagulants have inherent problems of producing pain and bruising. They are also difficult to administer, leading to low compliance. Oral anticoagulants are therefore gaining popularity for use as thromboprophylactic agents in hip and knee arthroplasty patients. There are not enough studies in the literature, however, to support their use in ambulatory trauma patients whose ankle fractures are being managed nonoperatively on an outpatient basis.

This study evaluated the efficacy of oral anticoagulants for preventing VTE in ambulatory trauma patients who required temporary lower limb immobilization for non-operative management of their ankle fractures. A total of 200 consecutive patients who presented to the fracture clinic with an ankle fracture that was managed in a plaster cast were included in this study. These patients were assessed for risk of developing VTE and high risk patients were administered an oral anticoagulant to prevent VTE.

There was only one case of an isolated distal DVT among the 200 patients.

This study shows that an oral anticoagulant was a safe alternative to injectable LMWH as a thromboprophylactic agent for ambulatory trauma patients requiring temporary lower limb immobilization for non-operative management of an ankle fracture.