Skip to main content
Log in

No effectiveness of anticoagulants for thromboprophylaxis after non-major knee arthroscopy: a systemic review and meta-analysis of randomized controlled trials

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Arthroscopic knee surgery is the most commonly performed orthopedic procedure worldwide and whether thromboprophylaxis should be undertaken after knee arthroscopy is still controversial. To evaluate the efficacy of thromboprophylaxis for deep venous thrombosis (DVT) and venous thromboembolism (VTE) after knee arthroscopic surgery. A meta-analysis was conducted using data from eight randomized trials (4148 patients) to compare thromboprophylaxis with placebo or no prophylactic treatment in patients undergoing knee arthroscopy. The benefits and harms of thromboprophylaxis were evaluated, including the incidence of asymptomatic DVT, symptomatic VTE, pulmonary embolism and anti-coagulation related adverse events. Thromboprophylaxis significantly decreased the incidence of DVT (95% CI 0.07–0.64, P = 0.006) and symptomatic VTE in patients undergoing knee arthroscopy (95% CI 0.23–0.76, P = 0.004), but not significantly decreased the incidence of pulmonary embolism (n.s.). Regarding to non-major knee arthroscopy surgery (simple surgical procedures without ligament reconstruction), no significant difference of the incidence of DVT or symptomatic VTE was noted between thromboprophylactic group and control group (n.s.). Thromboprophylactic treatment showed higher incidence rate of anti-coagulation related adverse events compared with the control group (95% CI 1.12–1.90, P = 0.005). There was no significant difference of the incidence of clinically relevant major bleeding between the two groups (n.s.). This meta-analysis indicates no effectiveness of thromboprophylaxis for preventing DVT or symptomatic VTE in patients undergoing non-major knee arthroscopy. Regarding to patient undergoing knee ligament construction, the thromboprophylactic strategy should mainly take into account the patient’s risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Ageno W, Dentali F, Imberti D (2004) A survey of thrombosis prophylaxis use in patients undergoing arthroscopic surgery. J Thromb Haemost 2:1901–1902

    Article  CAS  PubMed  Google Scholar 

  2. Altintaş F, Gürbüz H, Erdemli B, Atilla B et al (2008) Venous thromboembolism prophylaxis in major orthopaedic surgery: a multicenter, prospective, observational study. Acta Orthop Traumatol Turc 42(5):322–327

    Article  PubMed  Google Scholar 

  3. Beaufils P, Becker R, Kopf S et al (2017) Management of degenerative meniscus lesions: the 2016 ESSKA meniscus consensus. Knee Surg Sports Traumatol Arthrosc 5(2):335–346

    Article  Google Scholar 

  4. Berger RE, Pai M, Rajasekhar A (2017) Thromboprophylaxis after knee arthroscopy. N Engl J 376(6):580–583

    Article  Google Scholar 

  5. Bohensky MA, deSteiger R, Kondogiannis C et al (2013) Adverse outcomes associated with elective knee arthroscopy: a population-based cohort study. Arthroscopy 29(4):716–725

    Article  PubMed  Google Scholar 

  6. Born TR, Engasser WM, King AH et al (2014) Low frequency of symptomatic venous thromboembolism after multiligamentous knee reconstruction with thromboprophylaxis. Clin Orthop Relat Res 472(9):2705–2711

    Article  PubMed  PubMed Central  Google Scholar 

  7. Camporese G, Bernardi E, Noventa F (2016) Efficacy of rivaroxaban for thromboprophylaxis after knee arthroscopy (ERIKA). A phase II, multicentre, double-blind, placebo-controlled randomised study. Thromb Haemost 116(2):349–355

    PubMed  Google Scholar 

  8. Camporese G, Bernardi E, Prandoni P et al (2008) Low-molecular weight heparin versus compression stockings for thromboprophylaxis after knee arthroscopy: a randomized trial. Ann Intern Med 149:73–82

    Article  PubMed  Google Scholar 

  9. Canata GL, Chiey A (2003) Prevention of venous thromboembolism after ACL reconstruction: a prospective, randomized study. Presented at the International Society of Arthroscopy, Knee Surgery and Orthopedic Sports Medicine Congress, Auckland, New Zealand, 10–13 March 2003

  10. Chen D, Li Q, Rong Z, Yao Y, Xu Z, Shi D, Jiang Q (2017) Incidence and risk factors of deep venous thrombosis following arthroscopic posterior cruciate ligament reconstruction. Medicine (Baltimore) 96(22):e7074

    Article  Google Scholar 

  11. Dong JT, Wang X, Men XQ, Wang XF, Zheng XZ, Gao SJ (2015) Incidence of deep venous thrombosis in Chinese patients undergoing arthroscopic knee surgery for cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23(12):3540–3544

    Article  PubMed  Google Scholar 

  12. Erickson BJ, Saltzman BM, Campbell KA et al (2015) Rates of deep venous thrombosis and pulmonary embolus after anterior cruciate ligament reconstruction: a systematic review. Sports Health 7(3):261–266

    Article  PubMed  PubMed Central  Google Scholar 

  13. Falck-Ytter Y, Francis CW, Johanson NA et al (2012) Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guide lines. Chest 141(2 Suppl):e278S–e325S

    Google Scholar 

  14. Ganderup T, Jensen C, Holsgaard-Larsen A, Thorlund JB (2017) Recovery of lower extremity muscle strength and functional performance in middle-aged patients undergoing arthroscopic partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 5(2):347–354

    Article  Google Scholar 

  15. Haas S (2000) Deep vein thrombosis: beyond the operating table. Orthopedics 23(Suppl):S629–S632

    Google Scholar 

  16. Hegyes MS, Richardson MW, Miller MD (2000) Knee dislocation. Complications of nonoperative and operative management. Clin Sports Med 19:519–543

    Article  CAS  PubMed  Google Scholar 

  17. Hetsroni I, Lyman S, Do H et al (2011) Symptomatic pulmonary embolism after outpatient arthroscopic procedures of the knee: the incidence and risk factors in 418,323 arthroscopies. J Bone Joint Surg Br 93(1):47–51

    Article  CAS  PubMed  Google Scholar 

  18. Janssen RP, Reijman M, Janssen DM, van Mourik JB (2016) Arterial complications, venous thromboembolism and deep venous thrombosis prophylaxis after anterior cruciate ligament reconstruction: a systematic review. World J Orthop 18 7(9):604–617

    Article  PubMed  PubMed Central  Google Scholar 

  19. Kaye ID, Patel DN, Strauss EJ et al (2015) Prevention of venous thromboembolism after arthroscopic knee surgery in a low-risk population with the use of aspirin. Bull Hosp Jt Dis 73(4):243–248

    Google Scholar 

  20. Krych AJ, Sousa PL, Morgan JA et al (2015) Incidence and risk factor analysis of symptomatic venous thromboembolism after knee arthroscopy. Arthroscopy 31:2112–2118

    Article  PubMed  Google Scholar 

  21. Maletis GB, Inacio MD, Reynolds S, Funahashi TT (2012) Incidence of symptomatic venous thromboembolism after elective knee arthroscopy. J Bone J Surg Am 94(8):714–720

    Article  Google Scholar 

  22. Marlovits S, Striessnig G, Schuster R et al (2007) Extended duration thromboprophylaxis with enoxaparin after arthroscopic surgery of the anterior cruciate ligament: A prospective, randomized, placebo-controlled study. Arthroscopy 23:696–702

    Article  PubMed  Google Scholar 

  23. Martin CT, Pugely AJ, Gao Y, Wolf BR (2013) Risk factors for thirty-day morbidity and mortality following knee arthroscopy: a review of 12,271 patients from the national surgical quality improvement program database. J Bone Joint Surg Am 95:e98, 1–10

    Article  Google Scholar 

  24. Mauck KF, Froehling DA, Daniels PR et al (2013) Incidence of venous thromboembolism after elective knee arthroscopic surgery: a Historical cohort study. J Thromb Haemost 11(7):1279–1286

    Article  CAS  PubMed  Google Scholar 

  25. Michot M, Conen D, Holtz D et al (2002) Prevention of deep vein thrombosis in ambulatory arthroscopic knee surgery: a randomized trial of prophylaxis with low-molecular weight heparin. Arthroscopy 18:257–263

    Article  PubMed  Google Scholar 

  26. Muller-Rath R, Ingenhoven E, Mumme T et al (2010) Perioperative management in outpatient arthroscopy of the knee joint. Z Orthop Unfall 148(3):282–287

    Article  CAS  PubMed  Google Scholar 

  27. Struijk-Mulder MC, Ettema HB, Verheyen CC et al (2010) Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery. J Thromb Haemost 8(4):678–683

    Article  CAS  PubMed  Google Scholar 

  28. Struijk-Mulder MC, Ettema HB, Verheyen CC, Buller HR (2013) Deep vein thrombosis after arthroscopic anterior cruciate ligament reconstruction: a prospective cohort study of 100 patients. Arthroscopy 29:1211–1216

    Article  PubMed  Google Scholar 

  29. Sun Y, Chen D, Xu Z et al (2014) Deep venous thrombosis after knee arthroscopy: a systematic review and meta-analysis. Arthroscopy 30:406–412

    Article  PubMed  Google Scholar 

  30. Thorlund JB, Juhl CB, Roos EM, Lohmander LS (2015) Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ 350:h2747

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Van Adrichem RA, Nelissen RG, Schipper IB, Rosendaal FR, Cannegieter SC (2015) Risk of venous thrombosis after arthroscopy of the knee: results from a large population-based case–control study. J Thromb Haemost 13:1441–1448

    Article  PubMed  Google Scholar 

  32. Van Adrichem RA, Nemeth B, Algra A et al (2017) Thromboprophylaxis after knee arthroscopy and lower-leg casting. N Engl J Med 376(6):515–525

    Article  PubMed  Google Scholar 

  33. William C, Graham DC, Flanigan (2014) Venous thromboembolism following arthroscopic knee surgery: a current concepts review of incidence, prophylaxis, and preoperative risk assessment. Sports Med 44(3):331–343

    Article  Google Scholar 

  34. Wirth T, Schneider B, Misselwitz F et al (2001) Prevention of venous thromboembolism after knee arthroscopy with low-molecular weight heparin (reviparin): results of a randomized controlled trial. Arthroscopy 17:393–399

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank all the anonymous reviewers for their helpful suggestions on the quality improvement of our paper.

Funding

This study was supported by National Natural Science Foundation of China (Nos. 81501869, 81601983).

Author information

Authors and Affiliations

Authors

Contributions

HXL and GZ was responsible for the study concept and design and drafting of the manuscript. PS and QT was responsible for the trials selection and appraisal of methodological quality. QT and GZ participated in acquisition, analysis, and interpretation of data. XYP provided consultation of statistics and methodology. HXL were in charge of the study concept and design, supervised the study and critically revised the manuscript for important intellectual content. All authors read and approve the final manuscript.

Corresponding authors

Correspondence to Xiao-Yun Pan or Hai-Xiao Liu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zheng, G., Tang, Q., Shang, P. et al. No effectiveness of anticoagulants for thromboprophylaxis after non-major knee arthroscopy: a systemic review and meta-analysis of randomized controlled trials. J Thromb Thrombolysis 45, 562–570 (2018). https://doi.org/10.1007/s11239-018-1638-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-018-1638-x

Keywords

Navigation