From the Research
Routine VTE prophylaxis is generally not recommended after uncomplicated arthroscopic rotator cuff repair in patients without significant risk factors for thromboembolism. For most patients, early mobilization and adequate hydration are sufficient preventive measures. However, for patients with multiple risk factors such as advanced age, obesity, history of previous VTE, known thrombophilia, or prolonged immobilization, pharmacologic prophylaxis may be considered. In these higher-risk cases, low molecular weight heparin such as enoxaparin 40mg subcutaneously once daily or 30mg twice daily can be used, typically for 7-14 days postoperatively. Alternatively, aspirin 81-325mg daily for 2-4 weeks may be prescribed as a less aggressive option, although a study by 1 found that aspirin does not lead to a clinically significant reduction in either DVT or PE rate in patients undergoing RCR. The decision to use prophylaxis should be individualized based on the patient's risk-benefit profile, as the overall incidence of VTE after shoulder arthroscopy is relatively low (estimated at less than 1%) 1. The theoretical risk of bleeding complications, including postoperative hematoma formation which could compromise surgical outcomes, must be weighed against the benefit of VTE prevention. Early mobilization within the constraints of surgical protocol remains the cornerstone of prevention for most patients undergoing rotator cuff repair.
Some studies have investigated the use of intermittent pneumatic compression devices (IPCDs) in addition to pharmacologic prophylaxis, but the evidence is limited and of low quality 2, 3. A systematic review and meta-analysis by 2 found that adjunctive IPCD was associated with a decreased risk of VTE and DVT, but the quality of evidence was graded low. Another study by 4 found that IPCD can be used safely for prophylaxis of VTE in head/spinal trauma patients, but there was no statistically significant difference regarding a reduction in DVT, PE, or mortality between IPCD and LMWH groups.
In orthopedic oncology patients, a study by 5 found that aspirin and compression devices were comparable to low-molecular-weight heparin and PCD for VTE prophylaxis. However, the decision to use prophylaxis should be individualized based on the patient's risk-benefit profile, and the use of IPCDs or pharmacologic prophylaxis should be guided by the patient's specific risk factors and medical history.
Key points to consider when deciding on VTE prophylaxis after rotator cuff repair include:
- Patient's risk factors for thromboembolism, such as advanced age, obesity, history of previous VTE, known thrombophilia, or prolonged immobilization
- Type of surgery and anesthesia used
- Patient's medical history and current medications
- Potential risks and benefits of pharmacologic prophylaxis, including bleeding complications and postoperative hematoma formation
- Importance of early mobilization and adequate hydration in preventing VTE.