From the Research
DVT prophylaxis is not standard practice for most patients with ankle sprains requiring a moon boot in the outpatient setting. For typical ambulatory patients with isolated ankle injuries, the risk of developing deep vein thrombosis is relatively low, and routine anticoagulation is not recommended 1. However, certain high-risk patients may benefit from prophylaxis, including those with previous DVT/PE history, known thrombophilia, active cancer, significant immobility, or multiple risk factors. If prophylaxis is deemed necessary, options include low molecular weight heparin (such as enoxaparin 40mg subcutaneously once daily) or direct oral anticoagulants. The decision should be individualized based on the patient's complete risk profile, weighing the benefits against bleeding risks. Most patients should be encouraged to perform ankle exercises, maintain hydration, and ambulate as tolerated with the moon boot to promote circulation.
Some studies have investigated the use of graduated compression stockings (GCS) and intermittent pneumatic compression devices (IPCDs) for DVT prophylaxis, but these are typically used in hospitalized patients or those undergoing high-risk surgical procedures 2, 3, 4. The evidence suggests that GCS and IPCDs can be effective in reducing the risk of DVT, but the benefit may not outweigh the risks for most ambulatory patients with isolated ankle injuries.
Key considerations for DVT prophylaxis in patients with ankle sprains include:
- Patient risk factors, such as previous DVT/PE history or known thrombophilia
- Immobility and limited mobility
- Presence of multiple risk factors
- Potential benefits and risks of anticoagulation therapy
- Alternative methods for promoting circulation, such as ankle exercises and hydration.
In general, the primary reason routine prophylaxis isn't recommended is that the thrombosis risk for most ambulatory patients with isolated ankle injuries doesn't outweigh the potential complications of anticoagulation therapy 5.