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Clinical characteristics and outcomes of venous thromboembolic events after hallux valgus surgery: insights from the RIETE registry

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Abstract

Hallux valgus surgery (HVS) is one of the most common orthopedic procedures, often occurring in older adults. Guidelines provide inconsistent recommendations about venous thromboembolism (VTE) prophylaxis after HVS and data are scarce regarding VTE presentation and outcomes in this population. We reported the clinical characteristics and outcomes of VTE following HVS among patients enrolled in Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective multicenter VTE registry. We compared the findings with those of other patients in RIETE. Consecutive patients with VTE post HVS were included in the study. Baseline characteristics, administration of VTE prophylaxis prior to diagnosis, presenting symptoms and signs, risk factors for VTE, and 90-day outcomes including recurrent VTE, major bleeding and death were determined. A total of 54 patients with VTE post HVS were identified in RIETE [median age: 64 (interquartile range 56–71) years; 85.2% female] and were compared with 74,111 VTE patients who had not undergone HVS. Among those with VTE post HVS, 63.0% had received VTE prophylaxis, in contrast to 35.6% in the rest of the RIETE cohort. Simplified Pulmonary Embolism Severity Index was zero in 66.7% of the patients with pulmonary embolism post HVS and 33.3% of other RIETE patients (P = 0.011). Compared with other VTE patients, use of estrogens was higher in HVS group (13.0% vs 5.4%, P = 0.01). All patients with VTE post HVS (100%) and most of other VTE patients (99.6%) were treated with anticoagulation, most commonly with low-molecular weight heparins. In contrast to the rest of the patients in RIETE, the absolute number of all fatal and non-fatal outcomes at 90 days was zero in the post HVS group (i.e. no deaths, no recurrence of VTE, and no major bleeding). In a large registry of patients with VTE, all patients with VTE post HVS underwent anticoagulation. These patients had much better outcomes than the rest of VTE patients, with no deaths, recurrences or major bleeding events at 90-day follow-up.

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Acknowledgements

We express our gratitude to Sanofi Spain for supporting this Registry with an unrestricted educational grant. We also express our gratitude to Bayer Pharma AG for supporting this Registry. Bayer Pharma AG’s support was limited to the part of RIETE outside Spain, which accounts for a 25.28% of the total patients included in the RIETE Registry. We also thank the RIETE Registry Coordinating Center, S&H Medical Science Service, for their quality control data, logistic and administrative support and Prof.

Funding

RIETE registry is supported by research grants from Sanofi Spain and Bayer Pharma AG. The funders have no access to the database nor had any role in the design of the current study. They did not have access to the prepared manuscript, and did not have a role in the decision to submit the manuscript.

Author information

Authors and Affiliations

  1. Aged & Extended Care Services, Central Adelaide Local Health Network, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, Adelaide, SA, 5011, Australia

    Bavand Bikdeli & Renuka Visvanathan

  2. Adelaide Geriatrics Training and Research With Aged Care (GTRAC) Centre, School of Medicine, Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia

    Bavand Bikdeli & Renuka Visvanathan

  3. Division of Medical Subspecialties, Lyell McEwin Hospital, Adelaide, SA, Australia

    Bavand Bikdeli

  4. Fireman Vascular Center, Massachusetts General Hospital, Boston, MA, USA

    Ido Weinberg

  5. Department of Pneumonology, Hospital Universitario Araba, Vitoria-Gasteiz, Álava, Spain

    Agustina Rivas

  6. Department of Internal Medicine, Hospital General Virgen de La Luz, Cuenca, Spain

    José Antonio Nieto

  7. Department of Internal Medicine, Hospital Reina Sofía, Tudela, Navarre, Spain

    Ángel Sampériz

  8. Department of Internal Medicine, Hospital Comarcal de Axarquía, Málaga, Spain

    Mónica Loring

  9. Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Fernando Javier Vázquez

  10. Department of Internal Medicine – Pulmonary Division, Botucatu Medical School, São Paulo State University (UNESP), São Paulo, Brazil

    Hugo Hyung Bok Yoo

  11. Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY, USA

    Behnood Bikdeli

  12. Yale/YNHH Center for Outcomes Research & Evaluation, New Haven, CT, USA

    Behnood Bikdeli

  13. Cardiovascular Research Foundation (CRF), New York, NY, USA

    Behnood Bikdeli

  14. Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain

    Manuel Monreal

  15. Universidad Católica de Murcia, Murcia, Spain

    Manuel Monreal

Authors
  1. Bavand Bikdeli
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  2. Renuka Visvanathan
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  3. Ido Weinberg
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  4. Agustina Rivas
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  5. José Antonio Nieto
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  6. Ángel Sampériz
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  7. Mónica Loring
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  8. Fernando Javier Vázquez
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  9. Hugo Hyung Bok Yoo
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  10. Behnood Bikdeli
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  11. Manuel Monreal
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Corresponding author

Correspondence to Bavand Bikdeli.

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Conflict of interest

Dr. Behnood Bikdeli was supported by the National Heart, Lung, and. Blood Institute, National Institutes of Health, through Grant Number T32 HL007854. The content is the responsibility of the authors and does not necessarily represent the views of the NIH. Dr. Bikdeli reports that he has been a consulting expert (on behalf of the plaintiff) for litigation related to a specific type of IVC filters. Dr Ido Weinberg is on the scientific advisory board for Novate Medical and a non-compensated advisor for BTG. The current study is the idea of the investigators and has not been prepared at the request of a third party. Other authors have no conflict of interest to disclose.

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Appendix

Appendix

Coordinator of the RIETE Registry: Manuel Monreal.

RIETE Steering Committee Members: Paolo Prandoni, Benjamin Brenner and Dominique Farge-Bancel.

RIETE National Coordinators: Raquel Barba (Spain), Pierpaolo Di Micco (Italy), Laurent Bertoletti (France), Sebastian Schellong (Germany), Inna Tzoran (Israel), Abilio Reis (Portugal), Marijan Bosevski (R. Macedonia), Henri Bounameaux (Switzerland), Radovan Malý (Czech Republic), Peter Verhamme (Belgium), Joseph A. Caprini (USA), Hanh My Bui (Vietnam).

RIETE Registry Coordinating Center: S & H Medical Science Service. Members of the RIETE Group.

SPAIN: Adarraga MD, Agud M, Aibar MA, Amado C, Arcelus JI, Ballaz A, Barba R, Barbagelata C, Barrón M, Barrón-Andrés B, Blanco-Molina A, Camon AM, Cañas I, Carrasco C, Castro J, de Ancos C, del Toro J, Demelo P, Díaz-Pedroche C, Díaz-Peromingo JA, Encabo M, Falgá C, Farfán AI, Fernández de Roitegui K, Fernández-Capitán C, Fernández-Criado MC, Fidalgo MA, Flores K, Font C, Font L, Furest I, Galián JD, García MA, García-Bragado F, García-Morillo M, García-Raso A, Gavín O, Gayol MC, Gil-Díaz A, Gómez V, Gómez-Cuervo C, González-Martínez J, Grau E, Gutiérrez J, Hernández-Blasco LM, Hermosa-Los Arcos MJ, Iglesias M, Jara-Palomares L, Jaras MJ, Jiménez D, Jiménez R, Joya MD, Jou I, Lima J, Llamas P, Lobo JL, López-Jiménez L, López-Miguel P, López-Núñez JJ, López-Reyes R, López-Sáez JB, Lorente MA, Lorenzo A, Loring M, Lumbierres M, Madridano O, Maestre A, Marchena PJ, Martín del Pozo M, Martínez-García MA, Mella C, Mellado M, Monreal M, Morales MV, Nieto ML, Nieto JA, Núñez MJ, Olivares MC, Otalora S, Otero R, Panadero-Macía M, Pedrajas JM, Pellejero G, Pérez-Ductor C, Pérez-Jacoiste A, Pérez-Rus G, Peris ML, Porras JA, Rivas A, Rodríguez-Cobo A, Rodríguez-Hernández A, Rubio CM, Ruiz-Ruiz J, Ruiz-Sada P, Sahuquillo JC, Sala-Sainz MC, Salazar V, Salgueiro G, Sampériz A, Sánchez-Muñoz-Torrero JF, Sancho T, Soler S, Suriñach JM, Tolosa C, Torres MI, Uresandi F, Valle R, Vela JR, Vidal G, Villares P, ARGENTINA: Gutiérrez P, Vázquez FJ, Vilaseca A, BELGIUM: Vanassche T, Vandenbriele C, Verhamme P, BRAZIL: Yoo HHB, CZECH REPUBLIC: Hirmerova J, Malý R, ECUADOR: Salgado E, FRANCE: Benzidia I, Bertoletti L, Bura-Riviere A, Debourdeau P, Farge-Bancel D, Helfer H, Hij A, Mahé I, Moustafa F, GERMANY: Schellong S, ISRAEL: Braester A, Brenner B, Tzoran I, IRAN: Sharif-Kashani B, ITALY: Barillari G, Bilora F, Bortoluzzi C, Brandolin B, Ciammaichella M, Dentali F, Di Micco P, Folath M, Imbalzano E, Landolfi R, Maida R, Mastroiacovo D, Pace F, Pallotti G, Pesavento R, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tufano A, Visonà A, Zalunardo B, LATVIA: Gibietis V, Kigitovica D, Skride A, REPUBLIC OF MACEDONIA: Bosevski M, SWITZERLAND: Bounameaux H, Mazzolai L, USA: Bikdeli B, Caprini J, VIETNAM: Bui HM. Salvador Ortiz, Universidad Autónoma Madrid and Silvia Galindo, both Statistical Advisors in S&H Medical Science Service for the statistical analysis of the data presented in this paper.

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Bikdeli, B., Visvanathan, R., Weinberg, I. et al. Clinical characteristics and outcomes of venous thromboembolic events after hallux valgus surgery: insights from the RIETE registry. J Thromb Thrombolysis 49, 651–658 (2020). https://doi.org/10.1007/s11239-019-02025-2

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  • DOI: https://doi.org/10.1007/s11239-019-02025-2

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