The variation of anticoagulation prescribed in foot and ankle surgery in the UK - UK foot and ankle thrombo-embolism audit (UK-FATE)

Lyndon Mason; Jitendra Mangwani; Linzy Houchen-Wolloff; Aiden Smith; Lucy Teece; Sarah Booth; Karan Malhotra; UK-FATE Collaborative

doi:10.1016/j.fas.2024.06.005

The variation of anticoagulation prescribed in foot and ankle surgery in the UK - UK foot and ankle thrombo-embolism audit (UK-FATE)

Foot Ankle Surg. 2024 Jun 26:S1268-7731(24)00146-2. doi: 10.1016/j.fas.2024.06.005. Online ahead of print.

Authors

Lyndon Mason¹, Jitendra Mangwani², Linzy Houchen-Wolloff³, Aiden Smith⁴, Lucy Teece⁵, Sarah Booth⁵, Karan Malhotra⁶; UK-FATE Collaborative

Affiliations

¹ Liverpool University Hospitals NHS Foundation Trust, Liverpool L9 7AL, United Kingdom; University of Liverpool, Liverpool L69 3BX, United Kingdom. Electronic address: lwmason@liverpool.ac.uk.
² Academic Team of Musculoskeletal Surgery, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, United Kingdom.
³ University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester LE1 5WW, United Kingdom.
⁴ Department of Population Health Sciences, University of Leicester, Lancaster Road, Leicester LE2 7HA, United Kingdom.
⁵ Department of Population Health Sciences, University of Leicester, University Road, Leicester LE1 7RH, United Kingdom.
⁶ Foot & Ankle Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP, United Kingdom; Department of Orthopaedics & Musculoskeletal Science, University College London, Gower St, London WC1E 6BT, United Kingdom.

PMID: 38944567
DOI: 10.1016/j.fas.2024.06.005

Abstract

Introduction: Venous thrombo-embolism (VTE) is a recognised complication of foot and ankle surgery. There are multiple possible anticoagulation treatments available in the UK to mitigate the risk of developing VTE. Our primary objective was to assess the variability of chemical anticoagulation prescribed in patients undergoing foot and ankle procedures.

Methods: This was a UK-based national, multicenter, prospective audit spanning a collection duration of 9 months on all foot and ankle procedures, carried out in 68 UK centers between 1st June 2022 and 30th November 2022, with a further 3-month follow up period. All patients who underwent a foot and ankle surgical procedure (including Achilles tendon rupture treatment) were included in this study.

Results: Data on a total of 13,569 patients was submitted. Following data cleansing, 11,363 patients were available for further analysis, with anticoagulation data available for 11,099 patients. There were eleven different chemical anticoagulation treatments recorded across the cohort. A total of 3630 (31.95 %) patients received no chemical anticoagulation. The patients receiving chemical anticoagulation medication could be split into 4 main groups. The most common chemical anticoagulation received was low molecular weight heparin (LMWH) (6303, 84.4 % of patients receiving chemical anticoagulation). Aspirin was given in 4.1 % (308 patients), a Factor Xa inhibitor in 10 % (744 patients) and other anticoagulants (e.g. Warfarin) in 1.5 % (114 patients). The overall VTE rate in this sub analysis of patients receiving chemical anticoagulation, was 1.1 % (83 cases out of 7469). There was no significant difference seen in incidence of VTE between types of anticoagulants, when confounding factors were considered. The duration of post-operative chemical prophylaxis used by participants for most chemical anticoagulants was 6 weeks (64.50 %).

Conclusion: There was significant variability of chemical anticoagulants reported in the study, with five different categories of anticoagulants used (including no chemical anticoagulation), and none clearly superior/inferior. The duration of anticoagulation was consistent across types of thromboprophylaxis.

Keywords: Chemical thromboprophylaxis; UK-FATE; Venous thromboembolism.