Interventions for preventing venous thromboembolism in adults undergoing knee athroscopy

Ramos, J, Perrotta, C, Badariotti, G, Berenstein, G

Knee arthroscopy is a frequent surgical procedure. Arthroscopy procedures are considered minimally invasive. However, some patients will need extended surgical time, suffer injury and immobilization thus increasing the risk for thromboembolic events. Incidence of deep venous thrombosis (DVT) in patients undergoing knee arthroscopy is reported to be from 0.6% to 17.9% depending on the diagnostic method used. Different approaches are available for thromboprophylaxis (mechanical or pharmacological). To assess the effectiveness and safety of thromboprophylaxis to reduce the incidence of DVT in patients undergoing knee arthroscopy. We searched the Cochrane Peripheral Vascular Diseases Group Specialized Register (last searched October 2006) the CENTRAL (last searched Issue 4, 2006), MEDLINE (1966 to 2006), EMBASE (1980 to 2006), and Lilacs (1988 to 2006). We contacted specialists known to be involved in phlebology and interested in post thrombotic syndrome for details of unpublished and ongoing trials. Randomized clinical trials (RCTs) and controlled clinical trials (CCTs), whether blinded or not (i.e. double blinded, single blinded or unblinded) of all type of interventions, whether mechanical or pharmacological, single or in combination, used to prevent DVT in males and females over 18 years old undergoing knee arthroscopy. There was no restriction on language. Two authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. Four trials involving 527 predominantly male participants were included. The main weakness of the studies was the lack of correct stratification of the arthroscopic intervention. The relative risk (RR) of thrombotic events was 0.20 (95% confidence interval (CI); 0.07 to 0.57) comparing any type of low molecular weight heparin (LMWH) versus placebo. All thrombotic events but one (pulmonary embolism in the LMWH group) were distal venous thrombosis. Adverse events were most common in the intervention group than in the control group, RR 2.11 (95% CI 1.26 to 3.55). There were 66 episodes of adverse events. The number needed to harm was 20 for any adverse events. This meta-analysis suggests that LMWH reduces the incidence of distal DVT diagnosed by sonogram. The clinical benefit of this is uncertain. No strong evidence was found to conclude thromboprophylaxis is effective to prevent thromboembolic events and safe, in people with unknown risk factors for thrombosis, undergoing knee arthroscopy.