American College of Foot and Ankle Surgeons' Clinical Consensus Statement

Risk, Prevention, and Diagnosis of Venous Thromboembolism Disease in Foot and Ankle Surgery and Injuries Requiring Immobilization

Adam E. Fleischer, Bradley P. Abicht, Jeffrey R. Baker, Troy J. Boffeli, Daniel Jupiter, Valerie L. Schade

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

The purpose of this document is to provide guidance for physicians regarding the risk, prevention, and diagnosis of venous thromboembolism disease after foot and ankle surgery and while caring for lower extremity injuries that require ankle immobilization. A panel composed of all authors of this document reviewed the published evidence and, through a series of meetings, reached consensus regarding the viewpoints contained herein. We conclude that routine chemical prophylaxis is not warranted; rather, patients should be stratified and have a prevention plan tailored to their individual risk level. An effective venous thromboembolism prevention program is typically multimodal and focuses on addressing any modifiable risk factors, use of mechanical prophylaxis, early mobilization, and careful consideration of the use of chemical prophylaxis. The final decision regarding use and method(s) of prophylaxis adopted should be agreed upon by both the clinician and patient after a discussion of the potential benefits and harms as they relate to the individual. This should take place preferably during the preoperative visit or in the immediate post-injury setting, and it may need to be revisited during the course of care if the patient's risk level changes. Prompt recognition of the signs and symptoms of deep venous thrombosis following surgery or injury is important. Patients suspected of deep venous thrombosis should receive further work-up with either a D-dimer test or duplex venous ultrasound of the symptomatic leg, depending on their pretest probability for the disease. The latter can be determined using a validated clinical decision-making tool (e.g., Well's criteria).

Original languageEnglish (US)
Pages (from-to)497-507
Number of pages11
JournalJournal of Foot and Ankle Surgery
Volume54
Issue number3
DOIs
StatePublished - May 1 2015
Externally publishedYes

Fingerprint

Foot Diseases
Ankle Injuries
Venous Thromboembolism
Ankle
Immobilization
Foot
Consensus
Venous Thrombosis
Early Ambulation
Wounds and Injuries
Signs and Symptoms
Lower Extremity
Leg
Patient Care
Physicians
Surgeons

Keywords

  • Ankle
  • Deep venous thrombosis
  • Diagnosis
  • Foot
  • Injury
  • Prevention
  • Prophylaxis
  • Surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

American College of Foot and Ankle Surgeons' Clinical Consensus Statement : Risk, Prevention, and Diagnosis of Venous Thromboembolism Disease in Foot and Ankle Surgery and Injuries Requiring Immobilization. / Fleischer, Adam E.; Abicht, Bradley P.; Baker, Jeffrey R.; Boffeli, Troy J.; Jupiter, Daniel; Schade, Valerie L.

In: Journal of Foot and Ankle Surgery, Vol. 54, No. 3, 01.05.2015, p. 497-507.

Research output: Contribution to journalArticle

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