Optimizing Venous Thromboembolism Prophylaxis in Achilles Tendon Rupture: A Systematic Review of Current Evidence and Protocol Recommendations.

The Achilles tendon plays a vital role in maintaining normal gait and locomotion. The incidence of Achilles tendon rupture (ATR) has been increasing, mainly due to the rising popularity of recreational sports. This review assesses anticoagulation efficacy in preventing venous thromboembolism (VTEs) during ATR treatment and aims to establish an evidence-based prophylaxis protocol. Initially, a comprehensive search across PubMed, Scopus, Web of Science (WoS), and the Cochrane Library databases, and the citation analysis identified studies on VTE prophylaxis in patients with acute or chronic ATR. We summarized results qualitatively, focusing on VTE prevention, complications, and clinical outcomes while considering study quality, bias, and confounders in our analysis. Eight studies, involving 1199 patients with ATR, were analyzed for the efficacy of various VTE prophylaxis strategies. Risk stratification using validated tools, such as the Thrombosis Risk Prediction Following Cast Immobilization (TRiP(cast)) score, was consistently advocated. High-risk patients benefited substantially from pharmacological prophylaxis, typically low molecular weight heparin (LMWH) or rivaroxaban, for a minimum duration of 28 days. In contrast, patients assessed as low-risk effectively managed VTE risks through early mobilization, with supplementary mechanical prophylaxis when indicated. The importance of individualized monitoring for VTE symptoms, bleeding complications, and patient adherence was also highlighted, particularly addressing obesity, prior VTE episodes, pregnancy, and the type of surgical intervention. The findings from this review advocate for an individualized approach to VTE prophylaxis in Achilles tendon rupture patients. Employing structured risk assessments using validated tools, e.g., TRiP(cast) score, ensures targeted and effective prophylactic interventions, significantly reducing complications. Pharmacological prophylaxis (LMWH or rivaroxaban) is indicated in high-risk patients; however, its benefit in low-risk patients remains uncertain and inconsistently demonstrated across studies. In these patients, early mobilization, patient education, and mechanical prophylaxis may offer a safe alternative. Further high-quality, long-term studies are needed to optimize prophylaxis duration and refine patient-specific protocols, especially in low-risk patients, ultimately improving patient outcomes and safety in clinical practice.