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Metz R, Verleisdonk EJ, van der Heijden GJ. Insufficient Evidence for Routine Use of Thromboprophylaxis in Ambulatory Patients with an Isolated Lower Leg Injury Requiring Immobilization: Results of a Meta-Analysis. Eur J Trauma Emerg Surg. 2008;35(2):169-75doi: 10.1007/s00068-008-8015-y.
Metz, R., Verleisdonk, E. J., & van der Heijden, G. J. (2009). Insufficient Evidence for Routine Use of Thromboprophylaxis in Ambulatory Patients with an Isolated Lower Leg Injury Requiring Immobilization: Results of a Meta-Analysis. European journal of trauma and emergency surgery : official publication of the European Trauma Society, 35(2), 169-75. https://doi.org/10.1007/s00068-008-8015-y
Metz, Roderik, et al. "Insufficient Evidence for Routine Use of Thromboprophylaxis in Ambulatory Patients with an Isolated Lower Leg Injury Requiring Immobilization: Results of a Meta-Analysis." European journal of trauma and emergency surgery : official publication of the European Trauma Society vol. 35,2 (2009): 169-75. doi: https://doi.org/10.1007/s00068-008-8015-y
Metz R, Verleisdonk EJ, van der Heijden GJ. Insufficient Evidence for Routine Use of Thromboprophylaxis in Ambulatory Patients with an Isolated Lower Leg Injury Requiring Immobilization: Results of a Meta-Analysis. Eur J Trauma Emerg Surg. 2009 Apr;35(2):169-75. doi: 10.1007/s00068-008-8015-y. Epub 2008 Dec 08. PMID: 26814772.
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Eur J Trauma Emerg Surg. 2009 Apr;35(2):169-75. doi: 10.1007/s00068-008-8015-y. Epub 2008 Dec 08.

Insufficient Evidence for Routine Use of Thromboprophylaxis in Ambulatory Patients with an Isolated Lower Leg Injury Requiring Immobilization: Results of a Meta-Analysis.

European journal of trauma and emergency surgery : official publication of the European Trauma Society

Roderik Metz, Egbert-Jan M M Verleisdonk, Geert J M G van der Heijden

Affiliations

  1. Department of Surgery, Erasmus Medical Centre, Diakonessenhuis Utrecht, Rotterdam, The Netherlands. [email protected].
  2. Department of Surgery, Erasmus Medical Centre, 2040, 3000 CA, Rotterdam, The Netherlands. [email protected].
  3. Department of Surgery, Erasmus Medical Centre, Diakonessenhuis Utrecht, Rotterdam, The Netherlands.
  4. University Medical Centre Utrecht, Utrecht, The Netherlands.

PMID: 26814772 DOI: 10.1007/s00068-008-8015-y

Abstract

BACKGROUND: There are no generally accepted guidelines for the prevention of venous thromboembolism (VTE) in ambulatory patients requiring immobilization after an isolated lower leg injury. Our objective was to evaluate the effectiveness and safety of pharmacological interventions for preventing VTE in these patients.

STUDY DESIGN: Meta-analysis of randomized controlled trials.

MATERIALS AND METHODS: We searched PubMed/Medline, EMBASE and the Cochrane Central Register of Controlled Trials for trials with random allocation of thromboprophylaxis, notably low molecular weight heparin (LMWH) versus no prophylaxis or placebo, in ambulatory patients with below-knee or lower leg (including the knee joint) immobilization. Outcome was analyzed using MIX to calculate the pooled risk ratio/relative risk (RR) for each outcome, along with its 95% confidence interval (CI).

RESULTS: The RR of asymptomatic deep vein thrombosis (DVT) was 0.66 (95% CI 0.44; 1.02) for below-knee immobilization and 0.51 (95% CI 0.37; 0.70) for lower leg immobilization. Low molecular weight heparin versus no prophylaxis or placebo was evaluated. The incidence of symptomatic DVT and PE was too low to show any statistically significant difference between thromboprophylaxis and controls in both groups. Although only one adverse bleeding event was considered to bemajor, the RR for any adverse bleeding event was 1.94 (95% CI 1.03; 3.67).

CONCLUSION: There is insufficient evidence to warrant routine use of thromboprophylaxis in ambulatory patients with below-knee or lower leg immobilization after an isolated lower leg injury. The incidence of symptomatic VTE is too low to show a relevant clinical benefit from thromboprophylaxis.

Keywords: Immobilization; Low molecular weight heparin; Lower leg; Thromboprophylaxis; Thrombosis

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