Anticoagulation following anterior cruciate ligament reconstruction

Abstract

The topic of deep vein thrombosis (DVT) prophylaxis in anterior cruciate ligament (ACL) surgery has become an important topic as the frequency of arthroscopic ACL reconstruction continues to increase. The reported incidence of symptomatic DVT following ACL surgery is approximately 0.3 %, and the incidence of pulmonary embolism (PE) is 0.18 %. Several diagnostic tests exist, but ultrasound is most commonly used to diagnose DVT, whereas CT scan is used most frequently to diagnose a PE. Multiple risk factors, both patient and procedure specific, may affect a patient’s overall risk for developing VTE. Patient-specific risk factors include age, gender, previous history of VTE, oral contraceptives or hormone replacement therapy, varicose veins, smoking, obesity, history of malignancy, pregnancy, and an inherited or acquired thrombophilia. Procedure-specific factors include tourniquet time and type of anesthesia. The decision for the right form of thromboprophylaxis for a specific patient starts with proper risk assessment. Commonly used prophylaxis include: sequential compression devices, compression stockings, aspirin, low-molecular-weight heparin, and warfarin. Various guidelines for the selection of appropriate thromboprophylaxis exist, with the most frequently referenced being provided by the American College of Chest Physicians (ACCP). This chapter evaluates the topic of anticoagulation after ACL reconstruction. It will discuss the incidence and diagnosis of DVT, risk factors, and available thromboprophylaxis and highlight available scientific evidence, as well as national and international guidelines.