Use of Prophylaxis for Deep Venous Thrombosis and Pulmonary Embolism in Isolated Foot and Ankle Trauma

Deep venous thrombosis (DVT) and pulmonary embolism (PE) are relatively rare after foot and ankle surgery, especially after trauma. Diagnosing DVT is difficult, and even when it is discovered it does not necessarily clinically manifest on, for example, duplex ultrasound. Thus, it is often recommended that prophylaxis use be assessed on a case-by-case basis based on risk profile rather than being uniformly given or not prescribed.

We searched the National Trauma Data Bank Trauma Quality Programs Participant Use File for patients experiencing foot and ankle trauma from 2013 to 2017. Patients were identified using the International Classification of Diseases, 9th Revision codes. Procedures undergone by patients were classified into five categories: closed reduction with fixation, open reduction with or without fixation, closed reduction without fixation, immobilization or no treatment, and soft-tissue procedures (eg, wound debridement).

Roughly 60% of trauma admissions for foot and ankle injury included use of prophylaxis. Female sex and increased age predisposed a patient to prophylaxis use. Hispanic and self-pay patients were less likely to have prophylaxis prescribed. Those with risk factors such as hypertension or smoking and those with open injuries or rearfoot injuries were also more likely to receive prophylaxis. Approximately half of the foot and ankle trauma patients in this cohort were treated with DVT prophylaxis, including those without additional risk factors for DVT/PE.

Further study is needed to better elucidate whether prophylaxis use is driven by protocol or clinical decision-making. Although it is important to understand the epidemiology of DVT/PE, effectiveness of prophylaxis, and recommendations from associations, understanding community practice patterns can promote discussion with policymakers to create new or alter current institutional protocols that may not be specific to the foot and ankle.