DVT and Achilles tendon rupture - a better pill to swallow?

G. Scott, A. Biggs, A. Carne, M. Rogers, M. Solan

Background: The BOFAS Guidance regards Achilles rupture patients as particularly high risk for VTE. Many hospitals use 6-weeks of low molecular weight heparin (LMWH) injections which are unpleasant for patients and result in reduced compliance. An extended course of prophylaxis is advised following hip and knee arthroplasty, however Novel Oral Anti-Coagulant (NOAC) tablets are licensed. We offered Rivaroxaban to our Achilles patients as an alternative. Since this is “off-license”, we developed an information sheet and consent form. In this study we compared VTE prophylaxis outcomes in our Achilles rupture patients.

Methods: We retrospectively reviewed patients diagnosed during three different periods between 2010 and 2019. During the first patients were treated in any fracture clinic. Chemical prophylaxis was not always prescribed. In the second period patients were triaged to a Foot & Ankle clinic. VTE prophylaxis was universal but not standardised. The third period saw patients managed by one F&A surgeon using the Rivaroxaban protocol. Thromboembolic event or significant bleeding within 3 months of treatment were recorded outcomes.

Results: Two hundred and thirty patients with Achilles tendon rupture were identified. Thirty-one were excluded because they took anticoagulants already or had a DVT on initial USS. There were no secondary bleeding episodes or fatal PEs. Forty patients had no prophylaxis and 7.5% of these developed a symptomatic DVT or PE. Of the 80 patients managed with LMWH, 6.25% suffered a thromboembolic event. A total of 79 patients were given Rivaroxaban and zero suffered a DVT or PE.

Conclusion: Numbers here are small, but suggests Rivaroxaban is an appropriate alternative to LMWH. Poor compliance due to pain and bruising from injections isn't relevant with a tablet that also doesn't require any patient/family education. Rivaroxaban has led to improved VTE rates for patients with Achilles tendon rupture in our hospital with no complications.