From the Research
DVT prophylaxis is generally not routinely recommended for a 17-year-old male undergoing open metatarsal fixation unless specific risk factors are present. For most young, otherwise healthy patients with isolated foot fractures, early mobilization is the preferred prophylaxis strategy. If the patient has significant risk factors such as prolonged immobilization, obesity, personal or family history of thromboembolism, or known thrombophilia, pharmacological prophylaxis could be considered. In such cases, low molecular weight heparin such as enoxaparin 40mg subcutaneously once daily would be appropriate for the duration of reduced mobility (typically 2-4 weeks) 1. Mechanical prophylaxis with compression stockings or intermittent pneumatic compression devices can also be used during the period of immobilization. The decision should be individualized based on a thorough risk assessment, as the baseline risk of DVT in adolescents is very low compared to adults, and unnecessary anticoagulation carries bleeding risks.
Some key points to consider in the decision-making process include:
- The use of intermittent pneumatic compression (IPC) has been shown to be effective in preventing DVT, particularly in high-risk patients 2, 3, 4.
- The combination of IPC with low-molecular-weight heparin (LMWH) may be more effective than LMWH alone in preventing DVT in certain patient populations 1.
- Early mobilization, when safely possible, remains the cornerstone of DVT prevention in this population.
- The choice of prophylaxis should be based on a thorough risk assessment, taking into account the patient's individual risk factors and the potential benefits and risks of each prophylactic strategy.
Overall, the most recent and highest quality study 1 suggests that combining IPC with LMWH may be an effective strategy for preventing DVT in high-risk patients, but this approach may not be necessary for a young, otherwise healthy patient with a low risk of DVT.