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Cancer history increases chances of VTE after knee arthroscopy, study finds
Study investigators recommend chemoprophylaxis for the prevention of VTE in high-risk patients.
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A history of cancer and past venous thromboembolism are among the significant risk factors for developing venous thromboembolism after knee arthroscopy, according to researchers from the Mayo Clinic.
The findings were presented by study author Diane L. Dahm, MD, at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine.
“In our multivariate model, we found that risk factors for postoperative [venous thromboembolism] VTE included history of malignancy, history of prior VTE and two or more classic risk factors. Patients having at least two of the following risk factors had significantly higher risk of VTE: age over 65, [body mass index] BMI over 30, smoking, oral contraceptives or hormone replacement and chronic venous insufficiency.”
Dahm added, “We therefore recommend consideration of chemoprophylaxis to prevent VTE in high-risk patients following knee arthroscopy.”
Inclusion criteria
To determine the incidence of clinically relevant VTE following knee arthroscopy and to evaluate the potential risk factors associated with VTE, Dahm and colleagues reviewed the records of patients from a single institution who underwent knee arthroscopy between 1985 and 2005. Any VTE events that occurred within 4 weeks of the arthroscopic procedure were recorded. The team also assembled a 2:1 matched control group consisting of patients who underwent knee arthroscopy with the same surgeon either on the same day or immediately prior to the cases that developed a subsequent VTE.
“We excluded patients who were younger than 18 [years] at the time of the surgery or had undergone another surgery within the 3 months prior to knee arthroscopy,” Dahm said.
The investigators collected patients’ demographic information, previous medical history, surgical and anesthesia data preoperatively and perioperatively. The researchers also noted that chemoprophylaxis was not routinely used in the study.
In addition, they examined potential risk factors including gender, alcohol use, anti-coagulant use, history of malignancy, trauma to the lower extremity and prior knee surgery, Dahm noted.
Rates of VTE, DVT
Overall, 12,595 patients underwent knee arthroscopy during the study period. The investigators identified 43 cases of VTE — including 35 cases of deep vein thrombosis (DVT), five pulmonary embolisms and three DVTs that eventually progressed to a pulmonary embolism. The study revealed a 0.30% incidence for DVT and 0.06% rate for PE.
“Of note, of 12 DVTs of the peroneal vein, none went on to [pulmonary embolism],” Dahm said.
She added, “In our case control model, four patients in the VTE group had a history of malignancy (9.3%) vs. no patients in the control group (0%).” She told Orthopedics Today that there were two cases of breast cancer and one case each of thyroid cancer and melanoma. – by Robert Press
Reference:
- Morgan JA, Krych AJ, May JH, et al. Incidence of symptomatic venous thromboembolism after knee arthroscopy. Paper #8. Presented at the 2011 Annual Meeting of the American Orthopaedic Society for Sports Medicine. July 7-10. San Diego.
- Diane L. Dahm, MD, can be reached at the Mayo Clinic, 200 First Street S.W., Rochester, MN 55905; 507-284-2511; email: dahm.diane@mayo.edu.
- Disclosure: The authors have no relevant financial disclosures.