Thromboembolic complications after surgical fixation of bone metastases: A systematic review

J Surg Oncol. 2021 Dec;124(7):1182-1191. doi: 10.1002/jso.26601. Epub 2021 Jul 16.


Background: Patients undergoing a major orthopedic surgery for metastatic bone disease (MBD) are at high risk of developing venous thromboembolic (VTE) complications. Despite concerns, there is no consensus on the most effective strategy to prevent VTE in these patients. The purpose of this systematic review was to determine the VTE rate following the surgical management of MBD.

Methods: The databases MEDLINE, EMBASE, and CENTRAL were searched using keywords related to VTE and MBD requiring surgical management. Included studies reported VTE rates in patients with surgically managed MBD. Descriptive statistics and weighted mean totals were calculated.

Results: In total, 2082 abstracts were screened, and 29 studies were included. The overall VTE rate was 4.7%. Patients receiving surgery for impending pathologic fracture had a higher rate of VTE (5.6%) compared to patients with acute pathologic fractures (4.2%). Low-molecular-weight heparin was the most used chemoprophylaxis.

Conclusions: Relative to other cancer and orthopedic patients, the VTE rate is extremely high in patients with MBD. The discordant recommendations of thromboprophylaxis, and absence of research in this distinct and more granular surgical oncology subgroup, underpins the challenges associated with developing guidelines to lessen the VTE risks in the MBD patient population.

Keywords: metastatic bone disease; orthopedic oncology; thromboprophylaxis; venous thromboembolism.

Publication types

  • Systematic Review

MeSH terms

  • Anticoagulants / therapeutic use
  • Bone Neoplasms / complications*
  • Bone Neoplasms / secondary
  • Fracture Fixation / adverse effects*
  • Fractures, Spontaneous / etiology
  • Fractures, Spontaneous / surgery*
  • Heparin, Low-Molecular-Weight / therapeutic use
  • Humans
  • Postoperative Complications
  • Venous Thromboembolism / etiology*
  • Venous Thromboembolism / prevention & control


  • Anticoagulants
  • Heparin, Low-Molecular-Weight