Limited indication of postoperative anticoagulation based on age reduces the incidence of deep venous thrombosis after anterior cruciate ligament reconstruction: A retrospective study

Masaki Nagashima; Ryo Sasaki; Kentaro Tanaka; Hiroyuki Nagita; Masamitsu Suhara; Mitsuru Yagi

doi:10.1016/j.asmart.2026.05.002

Limited indication of postoperative anticoagulation based on age reduces the incidence of deep venous thrombosis after anterior cruciate ligament reconstruction: A retrospective study

Asia Pac J Sports Med Arthrosc Rehabil Technol. 2026 May 21:45:14-18. doi: 10.1016/j.asmart.2026.05.002. eCollection 2026 Jul.

Authors

Masaki Nagashima^{1

2}, Ryo Sasaki^{1

3}, Kentaro Tanaka^{1

4}, Hiroyuki Nagita⁵, Masamitsu Suhara⁵, Mitsuru Yagi^{2

6}

Affiliations

¹ Department of Orthopaedic Surgery, International University of Health and Welfare Mita Hospital 1-4-3, Mita, Minato-ku, Tokyo, 108-8329, Japan.
² Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852, Hatakeda, Narita City, Chiba, 286-8520, Japan.
³ Department of Orthopaedic Surgery, NHO Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan.
⁴ Department of Orthopaedic Surgery, Kawasaki Municipal Kawasaki Hospital, 12-1 Shinkawadori, Kawasaki-ku, Kawasaki City, Kanagawa, 210-0013, Japan.
⁵ Department of Vascular Surgery, International University of Health and Welfare Mita Hospital 1-4-3, Mita, Minato-ku, Tokyo, 108-8329, Japan.
⁶ Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita City, Chiba, 286-8520, Japan.

Abstract

Objective: Deep venous thrombosis (DVT) has the potential to develop into life-threatening pulmonary embolism which is a serious complication after anterior cruciate ligament reconstruction (ACLR). Advanced age (≥40 years) is a known risk factor for DVT. Anticoagulation is an effective pharmacological prophylaxis for DVT, but its indications after ACLR have not been established. This study aimed to investigate the incidence of DVT after ACLR when postoperative anticoagulation is administered to patients ≥40 years of age.

Methods: Anticoagulation group comprised 75 consecutive patients who underwent ACLR (including 5 revision surgeries) at our hospital between November 2021 and April 2024. Among those patients, patients ≥40 years old in Anticoagulation group received edoxaban at 30 mg/day on postoperative days 3-7 as pharmacologic prophylaxis for DVT. The historical control group not administered anticoagulation (No anticoagulation group) comprised 56 patients with 56 ACLRs (including 10 revision surgeries) performed at our hospital between April 2017 and September 2018. Propensity score matching was performed for age, and 48 patients were selected from each group and enrolled in this study. There were 16 patients in Anticoagulation group and 17 in No anticoagulation group who were ≥40 years old. DVT was diagnosed using ultrasonography of both legs performed at 1 week postoperatively. Complications associated with anticoagulation and hemoglobin (Hb) levels in patients ≥40 years old were investigated.

Results: After ACLR, DVT was detected in 2 patients (4.2%) in Anticoagulation group and 9 patients (18.8%) in No anticoagulation group. The incidence of DVT was thus significantly lower in Anticoagulation group (P = 0.025). All patients with DVT were asymptomatic. With regard to Hb levels in patients ≥40 years old, no significant difference was evident between groups. No complications associated with anticoagulation therapy, such as bleeding, were observed.

Conclusion: Anticoagulation administered to patients ≥40 years of age significantly reduced the incidence of DVT after ACLR without obvious adverse events. A limited indication of postoperative anticoagulation based on age may be beneficial in preventing DVT after ACLR.

Keywords: Anterior cruciate ligament; Anticoagulation; Deep venous thrombosis; Pharmacologic prophylaxis.