Venous Thromboembolism Prophylaxis and Hormonal Contraceptive Management Practice Patterns in the Perioperative Period for Anterior Cruciate Ligament Reconstruction.
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2022-04
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Abstract
Purpose
To evaluate the venous thromboembolism (VTE) prophylaxis practices of surgeons performing anterior cruciate ligament reconstruction (ACLR) in female patients using hormonal contraceptives.Methods
Our research team designed an investigational survey using branching logic that was made available to the AANA membership. The survey was designed to identify clinical decision making regarding VTE prophylaxis after ACLR in patients without risk factors for VTE, the counseling of patients about VTE risk associated with hormonal contraceptives, and the use of VTE prophylaxis after ACLR in patients taking hormonal contraceptives.Results
Ninety-four respondents completed the survey. Eighty-nine respondents identified their gender (63% male and 37% female respondents). Respondents reported performing the following number of ACLRs annually: more than 50 (40%), 30 to 50 (29%), 15 to 30 (29%), and fewer than 15 (2%). Of the respondents, 62 (67%) reported that VTE developed after ACLR in their patients (male patients only, 32%; female patients only, 24%; and both male and female patients, 34%). Sixty-seven percent used chemoprophylaxis after ACLR. Surgeons who asked about hormonal contraceptive use were more likely to be women (P = .01; odds ratio [OR], 4.2). Surgeons who changed their VTE prophylaxis plan as a result of asking about hormonal contraceptive use were more likely to be women (P = .02; OR, 2.8). Surgeons who asked about hormonal contraceptive use were more likely to have female patients with VTE after ACLR (P = .03; OR, 2.9). Surgeons who changed their VTE prophylaxis plan as a result of asking about hormonal contraceptive use were more likely to have female patients with VTE after ACLR (P = .001; OR, 4.6).Conclusions
There is no standard of care for VTE prophylaxis after ACLR. A surgeon's own gender and prior clinical experience with VTE after ACLR may influence his or her likelihood to consider a patient's hormonal contraceptive use regarding VTE risk after ACLR.Clinical relevance
The use of hormonal contraception is a risk factor for VTE in female patients undergoing ACLR. It is important to identify current practice patterns and the need for a standard of care.Type
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Christian, Robert A, Sarah T Lander, Nicholas A Bonazza, Emily K Reinke, Trevor A Lentz, Julie A Dodds, Mary K Mulcahey, Anne C Ford, et al. (2022). Venous Thromboembolism Prophylaxis and Hormonal Contraceptive Management Practice Patterns in the Perioperative Period for Anterior Cruciate Ligament Reconstruction. Arthroscopy, sports medicine, and rehabilitation, 4(2). pp. e679–e685. 10.1016/j.asmr.2021.12.010 Retrieved from https://hdl.handle.net/10161/27385.
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Emily Reinke
Dr. Reinke is the Senior Research Program Leader in Sports Medicine. She manages the divisional portfolio and research staff. While supporting the industry sponsored studies, her focus is on PI-initiated research of all areas of interest where she assists as needed with study design, protocol logistics, database design, EMR data extraction, analysis, project presentation, and grant preparation. Her personal expertise is in ACL research, as she has been a member of the Multicenter Orthopaedic Outcomes Network (MOON) knee group since 2007.
Trevor A. Lentz
Anne Cunanan Ford
General obstetrics and gynecology, women's wellness promotion and preventive health, menopause and the peri-menopausal transition, vulvar dermatology
Jocelyn Ross Wittstein
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