Abstract | March 29, 2023

Deep Vein Thrombosis Prophylaxis in Patients who Undergo Knee Arthroscopy

Udit Dave, B.S

Udit Dave, BS, Medical Student, MS3, Tulane University School of Medicine, New Orleans, LA; Emma Lewis, MS, Medical Student, MS3, Tulane University School of Medicine, New Orleans, LA; Victoria K. Ierulli, MS, Research Assistant, Department of Orthopaedics, Tulane University School of Medicine, New Orleans, LA; Mary K. Mulcahey, MD, Assistant Program Director, Department of Orthopaedics, Tulane University School of Medicine, New Orleans, LA.

Learning Objectives

  1. Understand that most RCTs endorse utilizing some form of DVT prophylaxis in knee arthroscopy patients.
  2. Summarize reasons for not employing DVT prophylaxis in some cases
  3. Identify specific DVT prophylaxis needs in high-risk patients

Background: Knee arthroscopy is a common procedure utilized by orthopaedic surgeons to repair ligaments. A common associated complication is deep vein thrombosis (DVT) which can be life threatening. DVT prophylaxis can be performed with medications including aspirin, anticoagulants, and factor Xa inhibitors. However, a standardized guideline of DVT prophylaxis in the knee arthroscopy setting does not exist. The primary aims of this systemic review are to summarize how DVT prophylaxis is employed for patients who undergo knee arthroscopy and to provide a universal suggestion for DVT prophylaxis in the setting of knee arthroscopy.

Methods: A systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed through PubMed, Embase, and Cochrane Library for studies published after 1998. Included studies evaluated males and females of any age group who underwent knee arthroscopy procedures, were prospective randomized controlled trials, and evaluated DVT prophylaxis regimens in patients undergoing knee arthroscopy. Studies that were not written in English, analyzed animals or cadavers, were not RCTs, did not directly evaluate patients undergoing knee arthroscopy, or did not study DVT prophylaxis were excluded.

Results: The initial search generated 300 studies, and 15 studies were ultimately included. DVT prophylaxis methodologies included compression stockings, aspirin, factor Xa inhibitors, low molecular weight heparin, and neuromuscular electrical stimulation. Overall, 7 of 15 (47%) studies supported DVT prophylaxis in all patients, 3 (20%) studies supported it for high-risk patients, and 5 (33%) studies did not support any DVT prophylaxis. Conclusions: A large proportion of RCTs utilizing primary data advocate for DVT prophylaxis in all (7 of 15) or a high-risk subset (3 of 15) of patients. Only 5 of 15 studies suggested that no DVT prophylaxis is needed after knee arthroscopy, and many cited low incidence of post-arthroscopy DVT as the driving force in decision making. Patients undergoing knee arthroscopy are at an increased risk for deep vein thrombosis. Factor Xa inhibitors and low molecular weight heparin drugs are safe and effective options for orthopaedic surgeons to perform DVT prophylaxis in knee arthroscopy patients, especially in patients who are at increased risk for post-operative DVT.



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