ArticleResearch and practice in thrombosis and haemostasis2025
Post-below-knee amputation venous thromboembolism and mortality in United States veterans.
Article in Research and practice in thrombosis and haemostasis, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
Background: Patients who undergo below-knee surgical amputation (BKA) are at risk of postoperative venous thromboembolism (VTE). Limited prior studies quantified the rate of VTE post-BKA or the association of VTE with survival in this population. Objectives: We aimed to assess the incidence of post-BKA VTE and the association with all-cause mortality in a cohort of United States veterans. Methods: This was a retrospective cohort study of veterans who underwent surgical BKA between October 2016 and January 2023. We identified VTE within 90 days post-BKA using a previously validated algorithm combining International Classification of Diseases codes with a new anticoagulant prescription, placement of an inferior vena cava filter, or death within 30 days. A time-dependent Cox proportional hazard model tested the association between VTE and death while adjusting for potential confounders. A sensitivity analysis removed individuals categorized as having an acute VTE based on the International Classification of Diseases for VTE plus death within 30 days. Results: A total of 6305 patients underwent a first-time surgical BKA. Of these, 132 experienced a VTE within 90 days post-BKA. Younger age was associated with a reduced risk of post-BKA VTE. After adjusting for confounders, VTE within 90 days of BKA was associated with a 3-fold increase in mortality (adjusted hazard ratio, 3.17, 95% CI, 2.12-4.17). Conclusion: Patients who had a VTE within 90 days of BKA had a higher mortality than those without VTE post-BKA. Future studies are warranted to confirm these findings and investigate strategies to prevent post-BKA VTE.
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