156 – Should routine VTE prophylaxis be administered to patients undergoing elbow arthroplasty?
Antoon Van Raebroeckx, Surena Namdari
Response/Recommendation: There is no appropriate data to guide a strong evidence-based recommendation regarding the need for venous thromboembolism (VTE) prophylaxis for patients undergoing elbow arthroplasty (EA). At minimum, intermittent pneumatic compression (IPC) and early post-operative ambulation are low-risk interventions that should be employed.
Strength of Recommendation: Consensus.
Rationale: Four studies reported on cases of VTE following EA1–4. One systematic review, published in 2021 assessed whether VTE prophylaxis is beneficial in upper limb major joint replacement surgery5. The weighted mean VTE incidence in EA across the four included articles was 0.49% (range from 0.2% to 0.8%). The total number of VTE events was 34, comprising of 7 pulmonary embolism (PE), 25 deep venous thrombosis (DVT), and the remaining 2 episodes unspecified. Mortality secondary to VTE was reported in one article, which described one death occurring from three cases of VTE1. No other complications were reported. VTE risk factors were not identified in any of the four included studies. VTE prophylaxis techniques were reported by one study, which described IPC and early post-operative ambulation, without the use of pharmacological prophylaxis1. The effects of VTE prophylaxis on overall risk reduction or complication rates have not been reported and no direct comparisons have been made between patients undergoing joint replacement with or without prophylaxis.
References:
1. Duncan SFM, Sperling JW, Morrey BF. Prevalence of pulmonary embolism after total elbow arthroplasty. J Bone Joint Surg Am. 2007;89(7):1452-1453. doi:10.2106/JBJS.F.01328
2. Jenkins PJ, Watts AC, Norwood T, Duckworth AD, Rymaszewski LA, McEachan JE. Total elbow replacement: outcome of 1,146 arthroplasties from the Scottish Arthroplasty Project. Acta Orthop. 2013;84(2):119-123. doi:10.3109/17453674.2013.784658
3. Krenek L, Farng E, Zingmond D, SooHoo NF. Complication and revision rates following total elbow arthroplasty. J Hand Surg Am. 2011;36(1):68-73. doi:10.1016/j.jhsa.2010.09.036
4. Zhou H, Orvets ND, Merlin G, et al. Total Elbow Arthroplasty in the United States: Evaluation of Cost, Patient Demographics, and Complication Rates. Orthop Rev (Pavia). 2016;8(1):6113. doi:10.4081/or.2016.6113
5. Kadhum M, Elniel AR, Furniss D. Is venous thromboembolism prophylaxis beneficial in upper limb major joint replacement surgery? A systematic review. Shoulder Elbow. 2021;13(2):119-130. doi:10.1177/1758573219896279