HealthDay News – The use of thromboprophylaxis seems not to prevent venous thromboembolism after knee arthroplasty or casting of the lower leg, according to a study published online in The New England Journal of Medicine.

Raymond A. van Adrichem, MD, from Leiden University Medical Center in the Netherlands, and colleagues conducted 2 parallel multicenter randomized trials with blinded outcome evaluation: the POT-KAST trial involving patients undergoing knee arthroscopy and the POT-CAST trial involving patients treated with casting of the lower leg. Patients were randomized to receive a prophylactic dose of low-molecular-weight heparin or no anticoagulant therapy.

The researchers found that venous thromboembolism occurred in 0.7% of patients in the treatment group and in 0.4% of patients in the control group in the POT-KAST trial (relative risk [RR]: 1.6; 95% confidence interval [CI], 0.4-6.8). Major bleeding occurred in 0.1% of patients in each group. Venous thromboembolism occurred in 1.4% of the treatment group and 1.8% of the control group in the POT-CAST trial (RR: 0.8; 95% CI, 0.3-1.7). There were no major bleeding events.

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“Prophylaxis with low-molecular-weight heparin for the 8 days after knee arthroscopy or during the full period of immobilization due to casting was not effective for the prevention of symptomatic venous thromboembolism,” the authors wrote.


van Adrichem RA, Nemeth B, Algra A, et al. Thromboprohylaxis after knee arthroscopy and lower-leg casting. N Engl J Med. 2016 Dec 3. doi:10.1056/NEJMoa1613303 [Epub ahead of print].