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Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization

  1. Mark Testroote1,*,
  2. Willem AH Stigter2,
  3. Loes Janssen3,
  4. Heinrich MJ Janzing4

Editorial Group: Cochrane Vascular Group

Published Online: 25 APR 2014

DOI: 10.1002/14651858.CD006681.pub3


How to Cite

Testroote M, Stigter WAH, Janssen L, Janzing HMJ. Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-leg immobilization. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD006681. DOI: 10.1002/14651858.CD006681.pub3.

Author Information

  1. 1

    Maastricht University Medical Centre, Department of Surgery, Maastricht, Netherlands

  2. 2

    Viecuri Medical Centre of Northern Limburg, Department of Surgery and Orthopaedic Surgery, Venlo, Limburg, Netherlands

  3. 3

    Viecuri Medical Centre of Northern Limburg, Department of Clinical Epidemiology, Venlo, Netherlands

  4. 4

    VieCuri Medical Centre of Northern Limburg, Department of Surgery, Venlo, Limburg, Netherlands

*Mark Testroote, Department of Surgery, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, 6202 AZ, Netherlands. marktestroote@yahoo.com. marktestroote@gmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 25 APR 2014

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This is not the most recent version of the article. View current version (06 AUG 2017)

References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Jorgensen 2002 {published data only}
  • Jorgensen PS, Warming T, Hansen K, Paltved C, Berg HV, Jensen R, et al. Low molecular weight heparin (Innohep) as thromboprophylaxis in outpatients with a plastercast; a venography controlled study. Thrombosis Research 2002;105(6):477-80.
  • Jorgensen PS, et al. Low molecular weight heparin (Innohep) thromboprophylaxis in outpatients with plaster casts. A phlebografic controlled study. Danish Orthopaedic Society Autumn Meeting. Copenhagen, Denmark, October 26-27 2000.
Kock 1995 {published data only}
  • Kock HJ, Schmit-Neuerburg KP, Hanke J, Hakmann A, Althoff M, Rudofski G. Ambulatory prevention of thrombosis with low molecular weight heparin in plaster immobilization of the lower extremity. Vasa Supplementum 1992;35:105-6.
  • Kock HJ, Schmit-Neuerburg KP, Hanke J, Hakmann A, Althoff M, Rudofsky G. Ambulant thrombosis prophylaxis with low-molecular heparin in plaster immobilisation of the lower extremities [Article in German]. Hefte zur der Unfallchirurg 1993;232:245-6.
  • Kock HJ, Schmit-Neuerburg KP, Hanke J, Hakmann A, Althoff M, Rudofsky G, et al. Ambulatory prevention of thrombosis with low molecular weight heparin in plaster immobilization of the lower extremity. Der Chirurg 1993;64(6):483-91.
  • Kock HJ, Schmit-Neuerburg KP, Hanke J, Rudofsky G, Hirche H. Thromboprophylaxis with low-molecular-weight heparin in outpatients with plaster-cast immobilisation of the leg. Lancet 1995 Aug 19;346(8973):459-61.
  • Kock HJ, Schmit-Neuerburg KP, Hanke J, Terwort A, Rudofsky G, Hirche H. Patient compliance during low molecular weight heparin thromboprophylaxis in outpatients with plaster cast immobilisation of the leg. Unfallchirurgie 1994;20(6):319-28.
  • Kock HJ, Schmitt-Neuerburg KP, Hanke J, Hakmann A, Althoff M, Rudofsky G. Prophylaxis of venous thromboembolism with low molecular weight heparin in surgical outpatients with immobilization of the lower limb by plaster cast. Haemostaseologie 1993;13 (suppl):S36-S39.
Kujath 1993 {published data only}
  • Habscheid W, Spannagel U, Kujath P, Schindler G. Prevention of thrombosis with low molecular weight heparin in ambulatory patients with injury of the lower extremity: an ultrasound study. Vasa Supplementum 1991;33:222-3.
  • Kujath P, Eckmann C. Thromboembolism prophylaxis in ambulatory surgery. Aktuelle Chirurgie 1995;30(6):372-5.
  • Kujath P, Spannagel U, Habscheid W. Incidence and prophylaxis of deep venous thrombosis in outpatients with injury of the lower limb. Haemostasis 1993;23(suppl 1):20-6.
  • Kujath P, Spannagel U, Habscheid W, Schindler G, Weckbach A. Thrombosis prevention in outpatients with lower limb injuries. Deutsche Medizinische Wochenschrift 1992;117(1):6-10.
Lapidus 2007a {published data only}
  • Lapidus L, Rosfors S, Ponzer S, Levander C, Elvin A, Elvin G, et al. Prolonged thromboprophylaxis with dalteparin after surgical treatment of Achilles tendon rupture - a randomized, placebo-controlled study. Journal of Bone and Joint Surgery - British Volume 2009;91-B (Suppl 1):165.
  • Lapidus LJ, Rosfors S, Ponzer S, Levander C, Elvin A, Laerfars G, et al. Prolonged thromboprophylaxis with Dalteparin after surgical treatment of achilles tendon rupture: a randomized, placebo-controlled study. Journal of Orthopaedic Trauma 2007;21(1):52-7.
Lapidus 2007b {published data only}
  • Lapidus LJ, Ponzer S, Elvin A, Levander C, Laerfars G, Rosfors S, et al. Prolonged thromboprophylaxis with Dalteparin during immobilization after ankle fracture surgery: a randomized, placebo-controlled, double-blind study. Acta Orthopaedica 2007;78(4):528-35.
Lassen 2002 {published data only}
  • Lassen MR, Borris LC, Nakov RL. Use of the low-molecular-weight heparin reviparin to prevent deep-vein thrombosis after leg injury requiring immobilization. New England Journal of Medicine 2002;347(10):726-30.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Abelseth 1996 {published data only}
  • Abelseth G, Buckley RE, Pineo GE, Hull R, Rose MS. Incidence of deep-vein thrombosis in patients with fractures of the lower extremity distal to the hip. Journal of Orthopaedic Trauma 1996;10(4):230-5.
Ageno 2004 {published data only}
  • Ageno W, Dentali F, Imberti D. A survey of thrombosis prophylaxis use in patients with lower limb fractures. Thrombosis and Haemostasis 2004;92(5):1166-7.
Ahmad 2003 {published data only}
  • Ahmad S, Bacher HP, Lassen MR, Hoppensteadt DA, Leitz H, Misselwitz F, et al. Investigations of the immunoglobulin subtype transformation of anti-heparin-platelet factor 4 antibodies during treatment with a low- molecular-weight heparin (clivarin) in orthopaedic patients. Archives of Pathology and Laboratory Medicine 2003;127:584-8.
Anonymous 1991 {published data only}
  • Anonymous. Low molecular weight heparin in the prevention of thrombosis during plaster cast immobilization. Therapiewoche 1991;41(43):2774.
Anonymous 1995 {published data only}
  • Anonymous. Plaster cast immobilization and deep vein thrombosis [Immobilisation platree et thrombose veineuse profonde]. Sang Thrombose Vaisseaux 1995;7(9):641-2.
Armbrecht 1993 {published data only}
  • Armbrecht A, Zenker W, Egbers HJ, Havemann D. Plaster-free, early functional after-care of surgically managed Achilles tendon rupture [Article in German]. Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen 1993;64(11):926-30.
Bauer 1944 {published data only}
  • Bauer G. Thrombosis following leg injuries. Acta Chirurgica Scandinavica 1944;90:229-49.
Breyer 1984 {published data only}
  • Breyer H, Koppenhagen K, Mabiki M, Rahmanzadeh R. The risk of thromboembolism due to plaster cast immobilisation and operation of the lower extremity [Thromboserisko durch Gipsimmobilisation und Operation an der unteren Extremitaet]. Hefte zur Unfallheilkunde 1984;164:423-4.
Bridges 2003 {published data only}
  • Bridges GG, Lee MD, Jenkins JK, Stephens MA, Croce MA, Fabian TC. Expedited discharge in trauma patients requiring anticoagulation for deep venous thrombosis prophylaxis: the LEAP Program. Journal of Trauma: Injury Infection and Critical Care 2003;54(2):232-5.
Eriksson 2001 {published data only}
  • Eriksson BI, Bauer KA, Lassen MR, Turpie AG. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after hip-fracture surgery. Steering Committee of the Pentasaccharide in Hip-Fracture Surgery Study. New England Journal of Medicine 2001;345(18):1298-304.
Freeark 1967 {published data only}
Geerts 1994 {published data only}
Geerts 1996 {published data only}
  • Geerts WH, Jay RM, Code KI, Chen E, Szalai JP, Saibil EA, et al. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. New England Journal of Medicine 1996;335(10):701-7.
Gehling 1994 {published data only}
  • Gehling H, Leppek R, Kunneke M, Gotzen L, Giannadakis K, Henkel J. Is prevention of thromboembolism in ambulatory and conservative therapy of rupture of the fibular ligament of the upper ankle joint necessary?. Unfallchirurg 1994;97(7):362-5.
Gehling 1998 {published data only}
  • Gehling H, Giannadakis K, Lefering R, Hessmann M, Achenbach S, Gotzen L. A comparison of acetylsalicylic acid with low-molecular-weight heparin for prophylaxis of deep-vein thrombosis in outpatients with injuries and immobilizing bandages of the lower limb. Unfallchirurg 1998;101(1):42-9.
Giannadakis 2000 {published data only}
  • Giannadakis K, Gehling H, Sitter H, Achenbach S, Hahne H, Gotzen L. Is a general pharmacologic thromboembolism prophylaxis necessary in ambulatory treatment by plaster cast immobilization in lower limb injuries?. Unfallchirurg 2000;103(6):475-8.
Goel 2009 {published data only}
  • Goel DP, Buckley R, de Vries G, Abelseth G, Ni A, Gray, R. Prophylaxis of deep-vein thrombosis in fractures below the knee: a prospective randomised controlled trial. Journal of Bone and Joint Surgery - British Volume 2009;91-B:388-94.
Greenfield 1997 {published data only}
  • Greenfield LJ, Proctor MC, Rodriguez JL, Luchette FA, Cipolle MD, Cho J. Posttrauma thromboembolism prophylaxis. Journal of Trauma: Injury Infection and Critical Care 1997;42(1):100-3.
Haas 1989 {published data only}
  • Haas S, Biegholdt M. Prevention of thromboembolism with low molecular weight heparin [Ambulante Thromboembolieprophylaxe mit niedermolekularem Heparin]. Hamostaseologie 1989;9(5):237-43.
Harenberg 1998 {published data only}
  • Harenberg J, Piazolo L, Misselwitz F. Prevention of thromboembolism with low-molecular-weight heparin in ambulatory surgery and unoperated surgical and orthopedic patients [Article in German]. Zentralblatt Chirurgie 1998;123(11):1284-7.
Hjelmstedt 1968 {published data only}
Kannus 1991 {published data only}
  • Kannus P, Renström P. Treatment for acute tears of the lateral ligaments of the ankle. Journal of Bone and Joint Surgery - American Volume 1991;73-A(2):305-12.
Knudson 1996 {published data only}
  • Knudson MM, Morabito D, Paiement GD, Shackleford S. Use of low molecular weight heparin in preventing thromboembolism in trauma patients. Journal of Trauma: Injury Infection and Critical Care 1996;41(3):446-59.
Knudson 2004 {published data only}
  • Knudson MM, Ikossi DG, Khaw L, Morabito D, Speetzen L. Thromboembolism after trauma: an analysis of 1602 episodes from the American College of Surgeons National Trauma Data Bank. Annals of Surgery 2004;240(3):490–6, discussion 496-8.
Kudsk 1989 {published data only}
Lassen 2000 {published data only}
  • Lassen M, Boris L, Backer P, Nakov R, Fareed J. Efficacy and safety of low molecular weight heparin (Elivarine) in the prophylaxis of venous thromboembolism in patients with brace immobilization after injury of the lower extremity. Blood 2000;96:491A.
Lippert 1995 {published data only}
  • Lippert H. Prevention of venous thromboembolism beyond the period of hospitalisation and during out-of-hospital surgery. Hamostaseologie 1995;15(3):167-8.
Marlovits 2007 {published data only}
  • Marlovits S, Striessnig G, Schuster R, Stocker R, Luxl M, Trattnig S, et al. A prospective, randomized, placebo-controlled Study of extended-duration post-discharge thromboprophylaxis with enoxaparin following arthroscopic reconstruction of the anterior cruciate ligament. Blood 2004;104(11):1764.
  • Marlovits S, Striessnig G, Schuster R, Stocker R, Luxl M, Trattnig S, et al. Extended-duration thromboprophylaxis with enoxaparin after arthroscopic surgery of the anterior cruciate ligament: a prospective, randomized, placebo-controlled study. Arthroscopy 2007;23(7):696-702.
Martinole 2003 {published data only}
  • Martinole A. Heparin prophylaxis for a leg cast?. Prescrire International 2003;12(66):159.
Micheli 1975 {published data only}
  • Micheli LJ. Thromboembolic complications of cast immobilization for injuries of the lower extremities. Clinical Orthopaedics and Related Research 1975;108:191-5.
NCT00843492 {published data only}
  • Anonymous. A study to evaluate the efficacy and safety of fondaparinux for the prevention of venous blood clots in patients with a plaster cast or other type of immobilization for a below-knee injury not needing surgery (FONDACAST). http://clinicaltrials.gov/ct2/show/NCT00843492?term=fondaparinux+and+thrombosis+and+prevention&rank=4.
Nesheiwat 1996 {published data only}
  • Nesheiwat F, Sergi AR. Deep venous thrombosis and pulmonary embolism following cast immobilization of the lower extremity. Journal of Foot and Ankle Surgery 1996;35(6):590-4.
Reilmann 1988 {published data only}
Reilmann 1993 {published data only}
Schultz 2004 {published data only}
  • Schultz DJ, Brasel KJ, Washington L, Goodman LR, Quickel RR, Lipchik RJ, et al. Incidence of asymptomatic pulmonary embolus in moderately to severely injured trauma patients. Journal of Trauma: Injury Infection and Critical Care 2004;56(4):727-33.
Selby 2010 {published data only}
  • Selby R, Geerts WH, Kreder HJ, Crowther MA, Kaus L, Sealey F. Clinically important venous thromboembolism (CIVTE) following isolated leg fractures distal to the knee: epidemiology & prevention: the D-KAF (dalteparin in knee-to-ankle fracture) trial. Journal of Bone and Joint Surgery - British Volume 2010;92-B(Suppl 1):7.
Spieler 1972 {published data only}
  • Spieler U, Preter B, Brunner U. Traumatic thromboses of the deep venous system in recent tibial fractures [Traumatische Thrombosen im tiefen Venensystem bei frischen Unterschenkelfrakturen]. Schweizerische Medizinische Wochenschrift 1972;102(43):1535-40.
Wolf 1992 {published data only}
  • Wolf N, Meiser H, Berg U, Goedicke M, Simonis G. Ambulatory prevention of thrombosis in a traumatologic patient sample. Vasa Supplementum 1992;35:109.
Zagrodnick 1990 {published data only}
  • Zagrodnick J, Kaufner HK. Ambulatory thromboembolism prevention in traumatology using self-injection of heparin. [German]. Unfallchirurg 1990;93(7):331-3.

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
NCT00881088 {unpublished data only}
  • Bruntink MM, Derksen RJ, Breederveld RS, van der Brand JGH, Sosef NL, Bakker FC, et al. Prophylaxis of thromboembolic complications trial: thromboprophylaxis needed in below knee plaster cast immobilization for ankle and foot fractures (PROTECT). http://clinicaltrials.gov/ct2/show/NCT00881088?term=fondaparinux+and+thrombosis+and+prevention&rank=5.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
ACCP 2012
  • Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141 (2 suppl):e278S-e325S.
Anonymous 1986
  • Anonymous. Consensus conference: prevention of venous thrombosis and pulmonary embolism. JAMA 1986;256(6):744-9.
Batra 2006
  • Batra S, Kurup H, Gul A, Andrew JG. Thromboprophylaxis following cast immobilisation for lower limb injuries-survey of current practice in United Kingdom. Injury 2006;37(9):813–7.
BCSH 2006
Bergqvist 2002
CBO 2006
  • CBO (Centraal Begeleidingsorgaan voor de intercollegiale toetsing). Concept directive, prevention and treatment of venous thromboembolism and secondary prevention of arterial thrombosis [Conceptrichtlijn diagnostiek, preventie en behandeling van veneuze tromboembolie en secundaire preventie arteriële trombose]. Quality Institute for Health Care (Kwaliteitsinstituut voor de Gezondheidszorg), the Netherlands 2006.
CBO 2008
  • CBO (Centraal Begeleidingsorgaan voor de intercollegiale toetsing). Concept directive, prevention and treatment of venous thromboembolism and sec- ondary prevention of arterial thrombosis [Conceptrichtlijn diagnostiek, preventie en behandeling van veneuze tromboembolie en secundaire preventie arteriële trombose]. Quality Institute for Health Care (Kwaliteitsinstituut voor de Gezondheidszorg), the Netherlands 2008.
Clagett 1995
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Gearhart 2000
  • Gearhart MM, Luchette FA, Proctor MC, Lutomski DM, Witsken C, James L, et al. The risk assessment profile score identifies trauma patients at risk for deep vein thrombosis. Surgery 2000;128(4):631-40.
Geerts 2004
  • Geerts WH, Pineo GF, Heit JA, Bergqvist D, Lassen MR, Colwell CW, et al. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004;126(3 Suppl):338S–400S.
Hayashino 2005
  • Hayashino Y, Goto M, Noguchi Y, Fukui T. Ventilaton-perfusion scanning and helical CT in suspected pulmonary embolism: Meta-analysis of diagnostic performance. Radiology 2005;234(3):740-8.
Hill 2002
  • Hill AB, Garber B, Dervin G, Howard A. Heparin prophylaxis for deep venous thrombosis in a patient with multiple injuries: an evidence-based approach to a clinical problem. Canadian Journal of Surgery 2002;45(4):282–7.
Kahn 2006
Kakkar 1994
  • Kakkar VV. Prevention of venous thromboembolism. In: Bloom AL, Forbes CD, Thomas DP, Tuddenham EGD editor(s). Haemostasis and thrombosis. 3rd Edition. Edinburgh: Churchill Livingstone, 1994:1361-79.
Kujath 1991
  • Kujath P, Spannagel U, Habscheid W. Incidence and prophylaxis of deep venous thrombosis in outpatients with injury of the lower limb. Haemostasis 1991;23(suppl 1):20–6.
Lensing 1989
  • Lensing AWA, Prandoni P, Brandjes D, Huisman PM, Vigo M, Tomasella G, et al. Detection of deep-vein thrombosis by real-time B-mode ultrasonography. New England Journal of Medicine 1989;320(6):342-5.
Lensing 1990
McLafferty 1998
  • McLafferty RB, Moneta GL, Passman MA, Brant BB, Taylor LM Jr, Porter JM. Late clinical and hemodynamic sequelae of isolated calf vein thrombosis. Journal of Vascular Surgery 1998;27(1):50–6.
Schellong 2007
Schulman 1986
  • Schulman S, Granqvist S, Juhlin-Dannfelt A, Lockner D. Long-term sequelae of calf vein thrombosis treated with heparin or low-dose streptokinase. Acta Medica Scandinavica 1986;219(4):349–57.
SIGN 2002
  • Scottish Intercollegiate Guidelines Network (SIGN). Prophylaxis of venous thrombosis. SIGN publication No. 62. http://www.sign.ac.uk/guidelines/fulltext/62/index.html 2002.
Testroote 2011
  • Testroote M, Morrenhof W, Janzing H. Prevention of venous thromboembolism in patients with below-knee immobilisation of the leg--survey of current practice in The Netherlands. Acta Chirurgica Belgica 2011;111(1):32-5.
Truijers 2005
  • Truijers M, Kranendonk SE, Nurmohamed MT. Thromboprophylaxis in general surgical practices in the year 2004: perioperative use during hospitalisation, during out-patient care and following plaster cast immobilisation. Nederlands Tijdschrift voor Geneeskunde 2005;149(45):2511–6.
Vaitkus 2004

References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
  5. References to other published versions of this review
Testroote 2008