Achilles tendon ruptures and venous thromboembolism - UK Foot and Ankle Thrombo-Embolism Audit (UK-FATE)

J. Mangwani, L. Mason, L. Houchen-Wolloff, K. Malhotra

Introduction: Although VTE rates are considered low after foot and ankle surgery, Achilles tendon ruptures have a higher reported incidence of VTE. However, there is an absence of agreement on contributing risk factors in the development of VTE and whether thromboprophylaxis is required. Our aim was to assess specific patient and surgical factors in patients with Achilles tendon ruptures developing VTE.

Methods: This was a multi-centre, prospective, national audit running from 1st June to 30th November 2022, with a further 3-month follow-up period. All foot and ankle operations and Achilles tendon ruptures were included, from 68 contributing UK centres. Primary outcomes included symptomatic VTE up to 90 days following Achilles tendon rupture treatment and VTE related mortality up to 90 days following treatment.

Results: There were 808 Achilles tendon ruptures which underwent conservative management (74.40%) and 278 which underwent surgery (25.60%). The VTE Incidence in conservatively treated Achilles ruptures was 4.08% compared to 2.52% in surgically treated ruptures, although the difference was not statistically significant (p=0.232). There were no VTE related mortalities. There was no significant difference between those who were weightbearing and those who were not (p=0.152), and no significant difference between those treated in plaster compared to those treated in a boot (p=0.652). The VTE rate was no different in those with and without anticoagulation (p=0.627) and the duration of anticoagulation was similar between groups. There was no difference in number of comorbidities or ASA grade between the groups. There was a slightly higher average age in the VTE group (54.35 vs 48.20 years, p=0.003).

Conclusion: The incidence of symptomatic VTE in Achilles tendon ruptures is high compared to other foot and ankle diagnoses. Apart from age, this study could not identify any obvious factors which increase the risk of VTE following Achilles tendon ruptures.