SLR - July 2009 - Timothy Fisher
Reference:
Nilsson-Helander, K., Thruin, A., Karlsson, J.; Eriksson, Bengt I. (2009). High incidence of deep venous thrombosis after Achilles tendon rupture: A prospective study. Knee Surgery, Sports Traumatology, Arthroscopy, DOI: 10.1007/s00167-009-0727-y.
Scientific Literature Reviews
Reviewed by: Timothy Fisher, DPM
Residency Program: Miami VA Medical Center
Podiatric Relevance:
This study provides useful data of the prevalence of DVT in patients that have experienced an Achilles tendon rupture.
Methods:
Ninety-five patients were screened for DVT after an acute Achilles tendon rupture using color duplex sonography (CDS) during the first 8 weeks of treatment. The patients were randomized into surgical versus non-surgical groups. All patients, regardless of surgical or non-surgerical intervention, were treated with a below knee cast in plantarflexion for 2 weeks followed by an adjustable lower leg brace for the subsequent 6 weeks. Range of motion was started at 10-14 days. The ambulatory surgical
patients were treated with a 500ml dose of Macrodex while the in-patient group was treated with a 2nd dose within the first post-op day. The non-surgical group was treated with anticoagulation per the treating physicians preference. Screening for DVT was performed via the CDS at 8 weeks after the trauma covering the external iliac, common femoral, deep femoral, superficial femoral, popliteal, gastroc, paired posterior-tibial and peroneal veins, as well as the proximal part of the anterior tibial and
proximal junctions of the greater and lesser saphenous veins. The primary diagnostic criterion was venous incompressibility in the transverse view. All exams were videotaped and the tapes were then reviewed by 2 vascular surgeons that were blinded by each other's diagnosis and to the primary diagnosis at the time of the exam. Of note, forty-one patients in the surgery group were treated with Macrodex prophylactically and an additional eight patients were given LMWH: 2 in the non-surgical group and 6 in the surgical group due to risk factors.
Results:
Thrity-two patients had a confirmed DVT using the CDS method, and three of those patients had a non-fatal pulmonary embolism (PE). DVT was found in 18/46 patients in the non-srugical group and 14/49 in the surgical group, but no significant difference was reported. Incidentally, of the ninety-five patients, seven had dalteparin prophylaxis daily for ten days and one of those patients developed a DVT. The principle finding in the study was a DVT rate of 34%, a total of 32 patients with 22 being asymptomatic. Three patients developed a PE and they were all in the non-surgical group.
Conclusions:
This data reports a 34% rate of DVT in patients suffering an Achilles tendon rupture within 2 months of injury. They found no significant difference in the incidence of DVT between the surgical versus the non-surgical groups. There is a need for further research to clarify the role of thromboprophylactic treatment in this group of patients.