Perspective:

While the use of LMWH or other antithrombotic agents are well established to prevent deep-vein thrombosis among patients undergoing major orthopedic surgeries (e.g., hip and knee arthroplasty), this study suggests that VTE prophylaxis may not be necessary for more minor surgeries (specifically knee arthroscopy) or lower leg casting. In fact, the results of these two studies contradict meta-analyses of smaller studies in each population. Importantly, this study established symptomatic VTE (not a combination of symptomatic and asymptomatic VTE) as the primary outcome, which was relatively rare in both treatment groups of both trials. This is somewhat different from prior trials where screening ultrasound was performed routinely and symptoms were assessed afterwards. Clinicians should discuss the risks and benefits of VTE prophylaxis with patients undergoing knee arthroscopy or lower leg casting, and can be re-assured if patients elect to forego VTE prophylaxis.