Saddle Pulmonary Embolism and Deep Vein Thrombosis Following Foot and Ankle Surgery While on Prophylactic Lovenox: A Case Report.

A patient developed saddle pulmonary embolism and deep vein thrombosis following foot and ankle surgery despite prophylactic anticoagulation.

• The patient was a 40-year-old male who underwent isolated Lisfranc ligament repair.
• The VTE event occurred approximately 1 month postoperatively.
• The patient was on prophylactic Lovenox (enoxaparin) at the time of the event.
• The complication was described as life-threatening.

The patient was using a selective estrogen receptor modulator (SERM) for off-label treatment of male infertility, which was identified as a contributory factor to his hypercoagulable state.

• The SERM was being used off-label for the treatment of male infertility.
• Selective estrogen receptor modulators are associated with increased hypercoagulability.
• The combination of SERM use, surgical intervention, and a period of non-weight bearing were collectively believed to contribute to the patient's relatively increased hypercoagulable state.
• Standard prophylactic Lovenox dosing was insufficient to prevent VTE in this clinical context.

VTE events following foot and ankle surgery are considered rare complications, typically occurring in high-risk patient populations.

• The authors characterize VTE as a rare complication of foot and ankle surgery.
• VTE prophylactic anticoagulation is initiated based on risk/benefit stratification for each individual patient undergoing foot and ankle surgery.
• Most instances of VTE following surgical procedures occur in particularly high-risk patient populations.
• This case was presented as depicting a rare complication of foot and ankle surgery.

Multiple concurrent risk factors including SERM use, surgery, and non-weight bearing contributed to VTE development despite prophylaxis.

• Three contributory factors were identified: selective estrogen receptor modulator use, surgical intervention, and a period of non-weight bearing.
• These factors are believed to have created a relatively increased hypercoagulable state in this patient.
• The case highlights the importance of VTE prophylaxis during the postoperative period.
• Standard prophylactic dosing may be insufficient when multiple hypercoagulable risk factors are present simultaneously.