Aspirin for ACLR, Knee Arthroscopy and Foot/Ankle Surgeries for Prevention of VTE

Aspirin for ACLR, knee arthroscopy and foot/ankle surgeries for prevention of VTE
Use USA, Canadian, Australian, or European guidelines (e.g. NICE Guidelines) that
recognize the types of surgery undertaken at a sport hospital (Knee arthroscopy,
ACLR, foot/ankle) and do not specifically address major orthopedic surgery (total hip
arthroplasty, total knee arthroplasty, hip fracture surgery), which are not performed
in a sport hospital.
Journal club critiques
Question Answer
1 What is the incident of VTE in
orthopedic surgeries in general?
(answer with reference)
Venous thromboembolism (VTE) is a
considered as a serious complication
during as well as after
hospitalization. As discussed by
Flevas et al. (2018), overall
incidence rate of VTE in general
surgery hospitalized patients is
approximately 10% to 40%, which
can goes up to 40% to 60% in main
orthopedic surgery.
2 What is rate or incidence of VTE in
sport surgeries related to ACLR?
(answer with reference)
Venous thromboembolism (VTE) is a
important perioperative risk
directly associated with a range of
common orthopaedic procedure such
as Anterior Cruciate Ligament
Reconstructive Surgery. The
incidence rate of Venous

thromboembolism in sport surgeries
related to ACLR is approximately
8.4% (Keller et al., 2018). In united
kingdom, the incidence rate of
Venous thromboembolism is
approximately 0.4%, where age is
considered as the major risk factors
for development of Venous
thromboembolism (Kraus et al.,
2019).
3 What is rate or incidence of VTE in
sport surgeries related to knee
arthroscopy? (answer with reference)
As discussed by Mauck et al. (2013)
incidence rate of VTE in sport
surgeries related to knee
arthroscopy without prophylaxis is
reported to be as low as 0.4% while
clinically identified. However,
researchers also suggested that the
incidence rate of Venous
thromboembolism (VTE) can be
high as 17.9% amongst patients
while diagnosed by early screening
of the asymptomatic patients who
has undergone surgeries associated
with knee arthroscopy.
4 What is rate or incidence of VTE in Literature suggested that venous

sport surgeries related to foot/ankle?
(answer with reference)
thromboembolism (VTE) is a rare
condition after the orthopedic
surgeries associated with foot and
ankle. However, it is considered as
the potentially lethal complication
after orthopedic foot and ankle
surgery. The incidence rate of
venous thromboembolism (VTE) in
foot and ankle surgeries is
approximately 0.6% (Huntley et al.,
2018).
5 Is VTE prophylaxis indicated in
conditions like meniscus repair where
the full body weight bearing might be
allowed?
As discussed by Mauck et al. (2013)
, Venous thromboembolism
prophylaxis contains pharmacologic
as well as nonpharmacologic
procedures for diminishing the risk
of deep vein thrombosis (DVT) as
well as pulmonary embolism (PE). On
the other hand, meniscus repair is
defined as an outpatient surgical
procedure, especially invasive
technique for repairing torn knee
cartilage. These two procedures are
not related and therefore, VTE
prophylaxis do not indicate in

conditions like meniscus repair.
6 What does the guidelines say about
the use of aspirin in orthopedic
surgeries related to knee and
foot/ankle surgeries:
a. Which guidelines mentioned
aspirin as an option for Knee
arthroscopy, ACLR, foot/ankle
surgeries
b. What is the recommended
aspirin dose
c. What is the recommended
aspirin duration?
d. When should it be started (6,
12, or 24 hours post the
mentioned surgeries?
a. 1. NICE guideline for venous
thromboembolism in over 16s:
reducing the risk of hospital-
acquired deep vein
thrombosis or pulmonary
embolism mentioned aspirin
as an option for Knee
arthroscopy, ACLR, foot/ankle
surgeries (Www.nice.org.uk.,
2020).
2. Apart from NICE guideline
The American Association of
Orthopedic Surgery (AAOS)
guideline recommended
aspirin as a potential
pharmacological options for
VTE prophylaxis in patients of
Knee arthroscopy, ACLR,
foot/ankle surgeries (Flevas et
al., 2018).
3. ACL Reconstruction
Rehabilitation Protocol
(Aaos.org., 2020)
b. Recommended dose for