Mody Kush, Chopra Avani A, Ahn David, Aynardi Michael, Lin Sheldon
Rutgers New Jersey Medical School, Newark, NJ, USA.
Penn State College of Medicine, Hershey, PA, USA.
Foot Ankle Orthop. 2025 Aug 20;10(3):24730114251363497. doi: 10.1177/24730114251363497. eCollection 2025 Jul.
The role of venous thromboembolism (VTE) chemoprophylaxis following ankle fracture surgery remains controversial. Although pharmacologic prophylaxis is standard in major orthopaedic procedures, its utility in foot and ankle trauma surgery is unclear because of low reported VTE rates and potential bleeding risks. Furthermore, no consensus exists on the cost-effectiveness of prophylactic agents in this population.
A literature review and the TriNetX Research Network were used to identify postoperative symptomatic VTE rates following ankle open reduction internal fixation (ORIF). The cost of treating a symptomatic VTE was estimated from existing literature and adjusted to 2025 US dollars. Drug pricing data were obtained from an online pharmacy database. A break-even analysis was conducted to calculate the absolute risk reduction (ARR) and number needed to treat (NNT) for each agent to be cost-effective. A subanalysis compared 30-day bleeding and transfusion rates between patients who received prophylaxis and those who did not.
The low and high literature-based VTE rates were 0.33% and 1.2%, whereas the TriNetX-derived VTE rate was 0.56%. Among 64 184 patients undergoing ankle ORIF without prophylaxis, 384 developed a symptomatic VTE. Aspirin (81 mg and 325 mg) and warfarin (5 mg) were cost-effective at all 3 VTE rates, with NNTs ranging from 9217 to 10 547. Enoxaparin (40 mg) was only cost-effective at the highest VTE rate (NNT = 131), whereas rivaroxaban (20 mg) was not cost-effective at any rate. Enoxaparin and rivaroxaban became cost-effective only when VTE treatment costs exceeded $50 000 and $1 500 000, respectively. Patients receiving prophylaxis had higher bleeding (0.56% vs 0.26%) and transfusion (0.82% vs 0.25%) rates ( < .001).
In summary, this study found that aspirin 81 mg, aspirin 325 mg, and warfarin are cost-effective for VTE chemoprophylaxis following ankle fracture fixation. Enoxaparin and rivaroxaban are generally not cost-effective, and their use may be appropriate only in high-risk patients.
Level IV, economic analysis.
踝关节骨折手术后静脉血栓栓塞（VTE）化学预防的作用仍存在争议。尽管药物预防在主要骨科手术中是标准做法，但由于报道的VTE发生率较低以及潜在的出血风险，其在足踝创伤手术中的效用尚不清楚。此外，对于该人群中预防药物的成本效益尚无共识。
通过文献综述和TriNetX研究网络确定踝关节切开复位内固定（ORIF）术后有症状VTE的发生率。根据现有文献估算有症状VTE的治疗成本，并调整为2025年美元。药物定价数据从在线药房数据库获取。进行盈亏平衡分析以计算每种药物具有成本效益时的绝对风险降低率（ARR）和需治疗人数（NNT）。一项亚分析比较了接受预防和未接受预防的患者之间的30天出血率和输血率。
基于文献的VTE发生率低和高值分别为0.33%和1.2%，而TriNetX得出的VTE发生率为0.56%。在64184例未接受预防的踝关节ORIF患者中，384例发生了有症状VTE。阿司匹林（81毫克和325毫克）和华法林（5毫克）在所有3种VTE发生率下均具有成本效益，NNT范围为9217至10547。依诺肝素（40毫克）仅在最高VTE发生率时具有成本效益（NNT = 131），而利伐沙班（20毫克）在任何发生率下均无成本效益。仅当VTE治疗成本分别超过50000美元和1500000美元时，依诺肝素和利伐沙班才具有成本效益。接受预防的患者出血率（0.56%对0.26%）和输血率（0.82%对0.25%）更高（P <.001）。
总之，本研究发现81毫克阿司匹林、325毫克阿司匹林和华法林在踝关节骨折固定术后VTE化学预防中具有成本效益。依诺肝素和利伐沙班一般不具有成本效益，仅在高危患者中使用可能合适。
IV级，经济分析。
