SLR - June 2018 - Vorice M. Batts

Retrospective Cohort Analysis of Pedal Procedures in the Thrombocytopenic Patient

Reference: Schmidt BM, Holmes CM. Retrospective Cohort Analysis of Pedal Procedures in the Thrombocytopenic Patient. Int J Low Extrem Wounds. 2017 Dec; 16 (4):284–288.

Scientific Literature Review

Reviewed By: Vorice M. Batts, DPM
Residency Program: Tucson Medical Center/Midwestern University Health Science Center, Tucson, AZ

Podiatric Relevance: Patient coagulation status is an important factor to note before planning elective or emergent surgical procedures in the foot and ankle. Patients with thrombocytopenia have a low platelet count and may have other comorbidities. This imbalance can lead to increased operative complications. Podiatric physicians perform many in-office procedures that result in bleeding. Understanding the approach and management in the hypocoagulable patient is beneficial, and it may lead to a decrease in patient morbidity. This article focused on safety strategies, management and the risk for complications in patients with thrombocytopenia who require in-office procedures.

Methods: This study was created at a large academic institution, a retrospective cohort analysis from DataDirect, for patients with foot- and ankle-related problems who needed in-office procedures from 2006 to 2016. Patients included had a history of thrombocytopenia, were 18 years or older and saw a foot specialist in an outpatient setting. The amount of office procedures and complications, at one year, were recorded. Transfusions were the primary complication followed by bleeding, recurrence of ulcer, infection, hospital admissions and death.  

Results: Of the 256 patients included, 80 had in-office procedures performed. Seventy-five patients had no complications following office procedures. This cohort study showed no significant difference in one-year follow-up complication rates in thrombocytopenic patients who had in-office procedures compared to those who did not. Five patients had transfusions within one year follow-up, and three of the five did not have procedures. Platelet count was the only indicator that was statistically different in characteristics of transfusion prior to procedures. One patient underwent toe amputation and did not require transfusion. Primary complication rates following in-office procedures showed no significant difference.

Conclusion: It is important to understand that thrombocytopenic patients have much comorbidity, but when performing in-office procedures, it is relatively safe. The author has concluded that understanding the protocols and management in patients who may need platelets are imperative for safe outcomes. Overall, there is no absolute contraindication for office procedures in this patient population, and common in-office procedures do not have an increased risk of transfusion on the thrombocytopenic patient. 

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