Department of Surgical and Perioperative Sciences, Orthopaedics, Sunderby Research Unit, Umeå University, Umeå, Sweden.
Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden.
Injury. 2022 Feb;53(2):732-738. doi: 10.1016/j.injury.2021.11.028. Epub 2021 Nov 15.
Venous thromboembolic events (VTE) are well-known and serious complications following a trauma to the lower extremities. There is an ongoing debate on the benefit of low-molecular-weight heparin (LMWH) as prophylaxis following ankle fracture treatment. We examined the association between the incidence of VTE and the use of LMWH-prophylaxis following an ankle fracture, as well as factors affecting the risk of VTE.
In this retrospective cohort study, data on ankle fractures and fracture treatment from the Swedish Fracture Register was linked to data from the Swedish National Patient Register and the Swedish Prescribed Drug Register. Patients with VTE and patients who received LMWH prophylaxis were identified. The treating orthopedic departments were sent a questionnaire about their guidelines regarding the use of LMWH prophylaxis.
222 cases of diagnosed VTE were identified among 14,954 ankle fractures. Orthopedic departments with higher-than-average use of LMWH prophylaxis among non-operatively treated ankle fractures had a lower incidence of VTE (OR 0.60, CI 0.39-0.92). Among operatively treated patients, departments with a guideline for the routine use of LMWH prophylaxis also had lower incidence of VTE (OR 0.56, CI 0.37-0.86). A later onset of VTE was seen among patients prescribed LMWH prophylaxis, with a mean of 56 days to onset (CI 44-67), compared to 39 days (CI 33-45) in patients without prescribed prophylaxis. During the first two weeks following injury, there was only one case of VTE in patients with prescribed LMWH, compared to 39 cases of VTE among patients without prescribed prophylaxis.
Routine use of LMWH in patients with operatively treated ankle fractures was associated with a lower incidence of VTE. A more frequent use of LMWH among patients with non-operatively treated ankle fractures were associated with a lower incidence of VTE. The onset occurred later among patients with LMWH-prophylaxis who still suffered a VTE.
下肢创伤后静脉血栓栓塞（VTE）是一种众所周知且严重的并发症。对于踝关节骨折治疗后使用低分子肝素（LMWH）预防 VTE 的益处，目前仍存在争议。我们研究了 VTE 的发生率与踝关节骨折后使用 LMWH 预防之间的关系，以及影响 VTE 风险的因素。
在这项回顾性队列研究中，我们将来自瑞典骨折登记处的踝关节骨折和骨折治疗数据与来自瑞典国家患者登记处和瑞典处方药物登记处的数据进行了关联。确定了 VTE 患者和接受 LMWH 预防的患者。向治疗骨科部门发送了一份关于其使用 LMWH 预防指南的问卷。
在 14954 例踝关节骨折中，共发现 222 例确诊 VTE。非手术治疗的踝关节骨折中 LMWH 预防使用率较高的骨科部门 VTE 发生率较低（OR 0.60，CI 0.39-0.92）。对于手术治疗的患者，常规使用 LMWH 预防指南的部门 VTE 发生率也较低（OR 0.56，CI 0.37-0.86）。接受 LMWH 预防的患者 VTE 发病时间较晚，平均发病时间为 56 天（CI 44-67），而未接受预防的患者为 39 天（CI 33-45）。在受伤后的前两周内，接受 LMWH 预防的患者中仅有 1 例 VTE，而未接受预防的患者中有 39 例 VTE。
手术治疗的踝关节骨折患者常规使用 LMWH 与 VTE 发生率较低相关。非手术治疗的踝关节骨折患者 LMWH 使用频率较高与 VTE 发生率较低相关。接受 LMWH 预防的患者 VTE 发生率仍较低，且发病时间较晚。
