According to a review of podiatric surgeries, the overall risk of venous thromboembolism (VTE) is low enough to obviate routine prophylaxis. Dr. Richard A. Mularski of Kaiser Permanente Northwest in Portland, Oregon, and colleagues in the April issue of Chest noted that prophylaxis is still indicated for patients with a history of VTE or risk factors for VTE. Dr. Mularski's team reviewed data on 7,264 patients who underwent 16,804 podiatric surgical procedures between 1999 and 2004. There were 22 symptomatic post-procedure VTEs (12 symptomatic deep vein thromboses and 10 pulmonary emboli), for an overall incidence of 0.30%. According to the researchers, 3 risk factors were significantly and independently associated with VTE, namely, a prior VTE, use of hormone replacement therapy (HRT) or oral contraceptives, and obesity. Specifically, they note, incidences of VTE were 4.6% in those with a prior VTE (RR, 23.0), 0.55% in women who used HRT or oral contraceptives (RR, 4.2), and 0.48% in obese individuals (RR, 3.0). Patients with 2 or more risk factors had a relative risk for VTE of 11.3 compared to patients with no risk factors. It was identified that the overall risk of VTE in podiatric surgery was low, suggesting that routine prophylaxis is not warranted. However, for patients with a history of VTE, periprocedure prophylaxis is suggested based on the level of risk. For podiatry surgery patients with two or more risk factors for VTE, periprocedure prophylaxis should be considered," the investigators conclude.