American Podiatric Medical Association
View all recommendations from this societyAugust 1, 2017; references updated June 21, 2018
Avoid routine use of pharmacologic DVT prophylaxis in elective foot and ankle surgery.
The decision of whether to implement pharmacologic prophylaxis should take into account the risk of deep venous thromboembolism (DVT) in the absence of prophylaxis, and the potential adverse effects associated with the use of pharmacologic prophylaxis. Routine use may in fact be harmful, particularly in patients at lowest risk for DVT. The final decision regarding use of pharmacologic prophylaxis should be agreed upon by the physician and patient after a discussion of the potential benefits and harms as they relate to the individual.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
(1–5) The American Podiatric Medical Association’s (APMA) Clinical Practice Advisory Committee, consisting of APMA members, board members, young members and liaisons with special interests in a variety of subspecialty areas within podiatric practice, formulated the recommendations for the ABIM Foundation’s Choosing Wisely Campaign. The Committee worked with podiatric colleagues to create an initial list of recommendations, which was reviewed and narrowed down to eight recommendations. The list of eight recommendations was further developed and distributed to the Committee for ranking in numerical order. Committee members were asked to rank the recommendations based on their relevance, timeliness, strength of supporting evidence and appropriateness for inclusion in the Choosing Wisely Campaign. The rankings and deliberation enabled the Committee to come to the final five recommendations, which were again reviewed to ensure appropriate evidence was used to support each recommendation. The final recommendations were approved by the Board of Trustees of the APMA before submission to the ABIM Foundation.
(6–10) The American Podiatric Medical Association (APMA) tasked their Clinical Practice Advisory Committee consisting of APMA members, board members, young members, and liaisons with special interests in a variety of subspecialty areas within podiatric practice to formulate the recommendations for the ABIM Foundation’s Choosing Wisely Campaign. The Committee worked with podiatric colleagues to create an initial list of recommendations, which was reviewed and narrowed down to nine recommendations. The list of nine recommendations was further developed and distributed to the Committee for ranking in numerical order. Committee members were asked to rank the recommendations based on their relevance, timeliness, strength of supporting evidence and appropriateness for inclusion in the Choosing Wisely Campaign. The rankings and deliberation allowed the Committee to come to the final five recommendations, which were again reviewed to ensure appropriate evidence was used to support each recommendation. The final recommendations were approved by the Board of Trustees of the APMA before submission to the ABIM Foundation.
APMA’s disclosure and conflict of interest policy can be found at www.apma.org.
Sources
Fleischer AE, Abicht BP, Baker JR, Boffeli TJ, Jupiter DC, Schade VL. American College of Foot and Ankle Surgeons’ Clinical Consensus Statement: Risk, prevention, and diagnosis of venous thromboembolism disease in foot and ankle surgery and injuries requiring immobilization. J Foot Ankle Surg. 2015;54:497-507.
Calder JD, Freeman R, Domeij-Arverud E, van Dijk CN, Ackermann PW. Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1409-20.
Robinson R, Wirt TC, Barbosa C, Amidi A, Chen S, Joseph RM, Fleischer AE. Routine use of low-molecular-weight heparin for deep venous thrombosis prophylaxis after foot and ankle surgery: A cost-effectiveness analysis. J Foot Ankle Surg. 2018;57:543-51.
