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Multicenter Study
. 2024 Nov 1;106-B(11):1249-1256.
doi: 10.1302/0301-620X.106B11.BJJ-2024-0128.R1.

UK Foot and Ankle Thromboembolism (UK-FATE)

Jitendra Mangwani  1   2   3 , Linzy Houchen-Wolloff  4 , Karan Malhotra  5 , Sarah Booth  6 , Aiden Smith  6 , Lucy Teece  6 , Lyndon W Mason  7 ; UK FATE Collaborative; UK FATE Collaborative; Rabia Shaikh  8 , Wilam Alfred  8 , Imobhio Okhifun  8 , Ece Cinar  8 , Nelson Bua  8 , Krishna Vemulapalli  8 , Ashok Acharya  8 , Richard Gadd  9 , John Money-Taylor  9 , Rohit Kantharaju  9 , Abhijit Bhosale  9 , Suchita Bahri  9 , Rosie Broadbent  9 , Isabella Drummond  10 , Neil Jones  10 , Savan Shah  10 , Thuwarahan Ravindrarjah  10 , Zaid Yasen  10 , Kunjshri Singh  10 , Ruqaiya Al-Habs  10 , Lucky Jeyaseelan  11 , Abdullah Habbiba  11 , Thomas Walker  11 , Maximilian Dewhurst  11 , Nisha Glasgow  11 , Dominic Eze  11 , Gary Carter  11 , Praveen Rajan  12 , Vijay Patil  12 , Omer Amer  12 , Kalim Malik  12 , Pranavan Pavanerathan  12 , Arijit Mallick  12 , Ilias Seferiadis  12 , Verity Currall  13 , Preetha Sadasivan  13 , Sunil Kumar  13 , Shahrukh R Sanjani  13 , Maria Ciaccio  13 , Brijesh Ayyaswamy  14 , Pradeepsyam Prasad  14 , Mr Anand  14 , Dr Sunilraj  14 , Suzanne Lane  14 , Swetha Prathap  14 , Raghubir Kankate  15 , Ioannis Aktselis  15 , Kinner Davda  15 , Arvind Vijapur  15 , Mohammed Tayyem  15 , Jackie Chau  15 , Muhammad S Azhar  16 , Simon Sturdee  16 , Halima Hussain  16 , Sarah Sonde  16 , Muhammad Q Luqman  16 , Rahy Farooq  16 , Gareth Wells  16 , Aneil Shenolikar  16 , Michiel Simons  17 , Paul Hodgson  17 , Rhys Thomas  17 , Sam Stevens  17 , Yahya Elhassan  18 , Adebowale Adeniyi  18 , Will Aspinall  18 , Vinay Joseph  19 , Miriam Day  19 , Aureola Tong  20 , Claire Joyner  20 , Muhammed Alzaranky  21 , Osman Elhassan  21 , Kishor Chhantyal  21 , Abhishek Arora  21 , Zain Abiddin  21 , Robert Kucharski  21 , Irfan Ahmad  22 , Junaid Zeb  22 , Usman Ishaq  22 , Jija Thomas  22 , Kowshik Jain  22 , Rupinderbir Deol  23 , Rad Faroug  23 , Karan Johal  23 , Simon Mordecai  23 , Miltiadis Argyropouos  23 , Amit Chawla  23 , Mohamed Ibrahim  23 , Marta Pereira  23 , Lynne Barr  24 , Elda Julies  24 , Francesca Hill  24 , Smriti Kapoor  25 , James Bailey  25 , Ishani Mukhopadhyay  25 , Sarina Rana  25 , Hamza Tarig  25 , Mahdi Qualaghassi  25 , Sheena Seewoonarian  25 , Barry Rose  25 , Georgina Crate  26 , Sarah Abbott  26 , Christopher Fenner  26 , Ryan Geleit  26 , Sohail Yousaf  26 , Nimra Akram  27 , Zahra Al-Hubeshy  27 , Bhavi Patel  27 , Mohamed Hussein  27 , Callum Clark  27 , Jasdeep Giddie  27 , Raman Dega  27 , Kishore Dasari  28 , Gurbinder Nandhara  28 , Pritesh Kumar  28 , Prateek Gupta  28 , Hope Poole  28 , Pamela Zace  28 , Farhan Alvi  29 , Jagan Jacob  29 , Raji Reddy  29 , Vaishnav Sateesh  29 , Andrea Gledhill  30 , James Craven  30 , Matt Cichero  30 , Ben Yates  30 , Ayla Newton  30 , John Grice  30 , Nicholas Fawcett  31 , Hossam Fraig  31 , Farouk Hamad  31 , Daniel Marsland  31 , Robin Elliot  31 , Yaser Ghani  32 , Suresh Chandrashekhar  32 , Ravi K Millan  32 , Andrew Clark  33 , Kashed Rahman  33 , Mark Sykes  33 , Zoe Little  34 , Jawaad Saleem  34 , Lewis Jolly  34 , Aman Jain  34 , Ansar Qadri  34 , Sophy Rymaruk  35 , Avadhut Kulkarni  36 , Mohanrao Garabadi  36 , Meraj Akhtar  36 , Munier Hossain  36 , Shamael Yunus  36 , Maleeha Saleem  36 , Joanna Fong  36 , Amirul Islam  37 , Ben Nusir  37 , James Chapman  37 , David Holmes  37 , Neville Mamoowala  37 , Kieran Almond  37 , Claire Wright  37 , Ethan Caruana  38 , Thomas Watson  38 , Georgia Allison  38 , Anand Pillai  39 , Imad Madhi  39 , Mazin Alsalihy  39 , Khadija Elamin  39 , Chee Rong Yip  39 , Lucy Tew  39 , Rohan Dahiya  39 , Thomas Goff  40 , Oliver Bagshaw  40 , Henry Slade  40 , Paul Andrzejowski  40 , Ayoub Gomati  40 , Chris Drake  40 , Jamie Hind  41 , Rebecca Morgan  41 , Ahmed Khalaf  41 , Adeel Ditta  41 , Arul Ramasamy  41 , Joshua McIntyre  42 , Calum Blacklock  42 , Scott Middleton  42 , Robert Clayton  42 , Alex Hrycaiczuk  43 , Christopher Thornhill  43 , Gowsikan Jeyakumar  43 , Delani Vaithilingam  43 , Kate Potter  43 , Bilal Jamal/Pete Chan  43 , Muyed Mohamed  44 , Debbie Fraser  44 , Ahmed Elhalawany  44 , James Beastall  44 , Gerard Cousins  44 , Perrico Nunag  44 , David Loveday  45 , Akshdeep Bawa  45 , Rebecca Gilmore  45 , Kerstin Schankat  45 , Andrew Walls  46 , Nicole Corin  46 , Peter Robinson  46 , Steve Hepple  46 , William Harries  46 , Andrew Riddick  46 , Ian Winson  46 , Luke Marsh  46 , Muhammad A Bashir  47 , Jigyasa Saini  47 , Henry Atkinson  47 , Rajiv Limaye  48 , Sarah Johnson-Lynn  48 , Mohit Sethi  48 , George Flanagan  49 , Akram Uddin  49 , Ian Reilly  49 , Rebecca Martin  50 , Andrea Pujol-Nichol  50 , Natalie Carroll  50 , Alexander Boucher  51 , Mustafa Alward  51 , Yuland Myint  51 , Katherine Butler  52 , Adrian Kendal  52 , Mark Bugeja  52 , Justin Mooteeram  52 , Farid Saedi  52 , Togay Koc  53 , Zeid Morcos  53 , Gregory Robertson  53 , Natal Holmes  53 , Howard Tribe  53 , Tim Pearkes  53 , Ahmed Soliman  53 , Anil Prasanna  54 , Kar Teoh  55 , Sanil Kamat  55 , Abhijit Bajracharya  55 , James Reeves  55 , Mbori Ngwayi  55 , Galal Imtiaz  55 , Noah Blackmore  55 , Benjamin Lau  56 , Arjun Naik  56 , Eleanor Tung  56 , Siddhartha Murhekar  56 , Robbie Ray  56 , Shirley Lyle  56 , Nilesh Makwana  57 , Kahlan A Kaisi  57 , Musab Al-Musabi  57 , Mike Dean  58 , Adrian Hughes  58 , Kimberley Shuttlewood  58 , Matthew Welck  59 , Shelain Patel  59 , Adam Sykes  59 , Mahesh M Thibbaiah  59 , Hosain Hadi  59 , Anil Haldar  59 , Amir G Ardakani  59 , Priyanka Jani  59 , Vladislav Kutuzov  60 , James Gibbons  60 , Daniel Trussler  60 , Eve Hawley  60 , Sabeen Akhtar  60 , Harshadkumar D Rajgor  61 , Basil Budair  61 , Hari Prem  61 , James Mckenzie  61 , Daniel Thurston  61 , Michael O'Sullivan  61 , Mohammed Elmajee  61 , Erika Pond  61 , Wajiha Zahra  62 , Catriona Heaver  62 , Kueni Igbagiri  63 , Andrew Gaukroger  63 , Matthew Solan  63 , Christian Peacock  63 , Ka S Fan  63 , Tristan Barton  64 , Derek Robinson  64 , Selina Graham  64 , Julian Zeolla  64 , Samuel Everett  65 , Mohammad Iqbal  65 , Lysander Gourbault  65 , Shashwat Singh  65 , Cary Tang  65 , Mariam Tarhini  65 , Shahrukh Khan  66 , Satishkumar Balasubramanian  66 , Caroline Lever  67 , Vaibhav Bansod  67 , Kartik Iyengar  67 , Abdul Wadood  67 , Lara McMillan  67 , Eugene Toh  67 , Stanley Masunda  68 , Simon Federer  68 , Faheem Ahmad  68 , Ahmed Lashin  68 , Ahmed Kaddah  68 , Emmanuel Oladeji  68 , Ed Dawe  68 , Ciaran Nolan  69 , Khalil El-Bayouk  69 , Vivek Dhukaram  69 , Anna Chapman  69 , Laura Beddard  70 , Alex Thomas  70 , Vipul Garg  70 , Heath Taylor  70 , Nikki Kelsall  70 , Charline Roslee  70 , Nimra Akram  71 , Hamish Lowdon  71 , Ahmed Kamel-Sherif  71 , Anette Jones  71 , Alistair Best  71 , Mate Zabaglo  71 , Junaid Sayani  72 , Olive Kyaw  72 , Chan Khin  72 , Ramla Ali  72 , Yousufuddin Shaik  72 , Natasha Hossain  72 , Lucia Valente  72 , Adam Ajis  72 , Abhijit Guha  73 , Melwyn Pereira  73 , Atif Ayoub  73 , Vlad Paraoan  73 , Nayeem Hali  73 , Charles Baird  73 , Raj Kugan  73 , Ahmad Abdallatif  73 , Mark Blomfield  74 , Gillian Jackson  74 , James Craven  74 , Anubhav Malhotra  74 , Aileen Toner  74 , Luke Render  74 , Connor Ashley  74 , Richard Limb  74 , Robert Smith  75 , Luke Hughes  75 , Hannah Matthews  76 , Fleur Shiers-Gelalis  76 , Jason Ting  76 , Stuart Place  76 , Adam Budgen  76 , James Stanley  76 , Charlie Jowett  76
Affiliations
Multicenter Study

UK Foot and Ankle Thromboembolism (UK-FATE)

Jitendra Mangwani et al. Bone Joint J. .

Abstract

Aims: Venous thromboembolism (VTE) is a potential complication of foot and ankle surgery. There is a lack of agreement on contributing risk factors and chemical prophylaxis requirements. The primary outcome of this study was to analyze the 90-day incidence of symptomatic VTE and VTE-related mortality in patients undergoing foot and ankle surgery and Achilles tendon (TA) rupture. Secondary aims were to assess the variation in the provision of chemical prophylaxis and risk factors for VTE.

Methods: This was a multicentre, prospective national collaborative audit with data collection over nine months for all patients undergoing foot and ankle surgery in an operating theatre or TA rupture treatment, within participating UK hospitals. The association between VTE and thromboprophylaxis was assessed with a univariable logistic regression model. A multivariable logistic regression model was used to identify key predictors for the risk of VTE.

Results: A total of 13,569 patients were included from 68 sites. Overall, 11,363 patients were available for analysis: 44.79% were elective (n = 5,090), 42.16% were trauma excluding TA ruptures (n = 4,791), 3.50% were acute diabetic procedures (n = 398), 2.44% were TA ruptures undergoing surgery (n = 277), and 7.10% were TA ruptures treated nonoperatively (n = 807). In total, 11 chemical anticoagulants were recorded, with the most common agent being low-molecular-weight heparin (n = 6,303; 56.79%). A total of 32.71% received no chemical prophylaxis. There were 99 cases of VTE (incidence 0.87% (95% CI 0.71 to 1.06)). VTE-related mortality was 0.03% (95% CI 0.005 to 0.080). Univariable analysis showed that increased age and American Society of Anesthesiologists (ASA) grade had higher odds of VTE, as did having previous cancer, stroke, or history of VTE. On multivariable analysis, the strongest predictors for VTE were the type of foot and ankle procedure and ASA grade.

Conclusion: The 90-day incidence of symptomatic VTE and mortality related to VTE is low in foot and ankle surgery and TA management. There was notable variability in the chemical prophylaxis used. The significant risk factors associated with 90-day symptomatic VTE were TA rupture and high ASA grade.

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Conflict of interest statement

J. Mangwani reports support from the Leicester Hospitals Charity, related to this study. J. Mangwani reports payment or honoraria for lectures, presentations, educational events from Orthosolutions, and royalties from Meshworks, unrelated to this study. K. Malhotra reports payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from NewClip Technics, unrelated to this study. L. W. Mason reports royalties or licenses, consulting fees, and patents planned, issued or pending from Orthosolutions, unrelated to this study.

References

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