Analysis of perioperative risk factors for deep vein thrombosis in patients with femoral and pelvic fractures

Abstract Objective Clinical characteristics, anticoagulant protocols, and risk factors of deep vein thrombosis (DVT) in patients with femoral and pelvic fractures were analyzed throughout the perioperative period to provide references for early identification and optimization of risk factors. Methods This was a retrospective study. A total of 569 patients undergoing surgery of femoral and pelvic fractures from May 2018 to December 2019 were included. The clinical data including general conditions, trauma, surgery, anticoagulant protocols, and laboratory indexes were collected. According to the results of deep vein Doppler ultrasonography of the lower extremities, the patients were divided into non-DVT group and DVT group. Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors of preoperative and postoperative DVT. Results The incidence of DVT was 40.25% and preoperative DVT was 26.71%, which was higher than the incidence of postoperative DVT of 17.22%. Most of them were thrombus on the affected side (60.26%) and distal thrombus (81.66%). The average time of DVT formation was 6.55 ± 0.47 days after trauma and 6.67 ± 0.48 days after surgery. Chronic obstructive pulmonary disease (COPD), anemia, hypoproteinemia, non-anticoagulation before surgery, delayed anticoagulation after trauma and admission, high-energy trauma, multiple injuries, drinking history, and advanced age were independent risk factors for perioperative DVT. The increased level of fibrinogen degradation products was an independent risk factor for preoperative DVT. These risk factors were identified to be independently associated with postoperative DVT, including intraoperative blood transfusion, postoperative blood transfusion, pulmonary infection, preoperative non-anticoagulation, postoperative delayed anticoagulation, preoperative waiting time > 7 days, operative time > 2 h, c-reactive protein, fibrinogen level, platelet count 1 day after surgery, c-reactive protein, fibrinogen, and hemoglobin levels 3 days after surgery, comminuted fracture. Conclusions At present, anticoagulation and other DVT prevention and treatment programs have not changed the current situation that the incidence of DVT is still high. Through the analysis of the risk factors of DVT throughout the perioperative period, optimizing the perioperative blood transfusion, preoperative lung disease, hypoproteinemia, anemia, inflammation, etc., and surgery as soon as possible after trauma may further reduce its incidence.

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Analysis of Perioperative Risk Factors for Deep Vein Thrombosis in Patients With Femoral and Pelvic Fractures

10.21203/rs.3.rs-74152/v1 ◽

2020 ◽

Author(s):

Linqin Wu ◽

Bo Cheng

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Blood Transfusion ◽

Perioperative Period ◽

Pelvic Fractures ◽

C Reactive Protein ◽

Vein Thrombosis ◽

Reactive Protein ◽

Independent Risk Factors ◽

Deep Vein

Abstract Objective: Clinical characteristics, anticoagulant protocols and risk factors of deep Vein thrombosis (DVT) in patients with femoral and pelvic fractures were analyzed throughout the perioperative period to provide references for early identification and optimization of risk factors.Methods: This was a retrospective study. A total of 569 patients undergoing surgery of femoral and pelvic fractures from May 2018 to December 2019 were included. The Clinical data including general conditions,trauma, surgery,anticoagulant protocols and laboratory indexes were collected.According to the results of deep vein Doppler ultrasonography of the lower extremities, the patients were divided into non-DVT group and DVT group.Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors of preoperative and postoperative DVT.Results: The incidence of DVT was 40.25%, PE was 1.93%, and preoperative DVT was 26.71%,which was higher than the incidence of postoperative DVT of 17.22%. Most of them were thrombus on the affected side (60.26%) and distal thrombus (81.66%).The average time of DVT formation was 6.55±0.47 days after trauma and 6.67±0.48 days after surgery. Chronic obstructive pulmonary disease(COPD), anemia, hypoproteinemia, non-anticoagulation before surgery, delayed anticoagulation after trauma and admission, high energy trauma, multiple injuries, drinking history, and advanced age were independent risk factors for perioperative DVT.The increased level of fibrinogen degradation products was an independent risk factor for preoperative DVT. These risk factors were identified to be independently associated with postoperative DVT, including intraoperative blood transfusion, postoperative blood transfusion, pulmonary infection, preoperative non-anticoagulation, postoperative delayed anticoagulation, preoperative waiting time > 7d, operative time > 2h, c-reactive protein, fibrinogen level, platelet count 1 day after surgery, c-reactive protein, fibrinogen, and hemoglobin levels 3 days after surgery, comminuted fracture.Conclusions: At present, anticoagulation and other DVT prevention and treatment programs have not changed the current situation that the incidence of DVT is still high. Through the analysis of the risk factors of DVT throughout the perioperative period, optimizing the perioperative blood transfusion, preoperative lung disease, hypoproteinemia, anemia, inflammation, etc., and surgery as soon as possible after trauma may further reduce its incidence.

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The Perioperative Deep Vein Thrombosis in Lower Extremities in Patients With Pelvic Fracture: A Case-Control Study

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/10760296211033024 ◽

2021 ◽

Vol 27 ◽

pp. 107602962110330

Author(s):

Yun Yan ◽

Baobao Zhang ◽

Jie Yang ◽

Yan Zhang ◽

Lei Zhang ◽

...

Keyword(s):

Risk Factors ◽

Blood Transfusion ◽

Pelvic Fracture ◽

Protective Factor ◽

Lower Extremities ◽

Pelvic Fractures ◽

Vein Thrombosis ◽

Before And After ◽

Independent Risk Factors ◽

Deep Vein

This study was to investigate the incidences of DVT in lower extremities after pelvic fracture before and after operation, and explore the risk factors. The records of patients with pelvic fractures receiving operation were collected. The patients were examined by preoperative and postoperative ultrasonography, and divided into thrombosis group and non-thrombosis group according to the preoperative and postoperative ultrasonographic results. Totally, 128 patients with pelvic fractures were included in this study. The incidence of DVT was 21.09% preoperatively, and increased to 35.16% postoperatively. Peripheral DVT constituted 92.60% and 86.67% of preoperative and postoperative DVTs, respectively. The results showed that age (odds ratio [OR] = 1.07; 95% CI: 1.01-1.12; P = 0.013), fracture classification (OR = 3.80; 95% CI: 1.31-11.00; P = 0.014) and D-dimer at admission (OR = 1.04; 95% CI: 1.00-1.08; P = 0.029) were independent risk factors of preoperative DVT, and female (OR = 0.21; 95% CI: 0.06-0.81; P = 0.023) was independent protective factor. In addition, age (OR, 1.06; 95% CI, 1.00-1.11; P = 0.026), operative blood transfusion (OR, 1.34; 95% CI, 1.05-1.72; P = 0.020) were independent risk factors of postoperative DVT. In conclusion, the DVT prevention strategy has not changed the high incidence of DVT in pelvic fractures, and orthopedic surgeons should pay more attention to perioperative DVT. When a male or patient with Tile-C type pelvic fracture is at admission, it is should be reminded that the screening the DVT in lower extremities. In addition, the surgeon should stanch bleeding completely, to reduce the blood transfusion and formation of DVT.

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Incidence and Risk Factors of Deep Vein Thrombosis in Patients With Pelvic and Acetabular Fractures

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029619845066 ◽

2019 ◽

Vol 25 ◽

pp. 107602961984506 ◽

Cited By ~ 5

Author(s):

Pengfei Wang ◽

Utku Kandemir ◽

Binfei Zhang ◽

Baohui Wang ◽

Jiahao Li ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Demographic Data ◽

Pelvic Fractures ◽

Acetabular Fractures ◽

Associated Injuries ◽

Time To Surgery ◽

Vein Thrombosis ◽

Independent Risk Factors ◽

Deep Vein

This study aimed to investigate the incidence and risk factors for deep vein thrombosis (DVT) in patients with pelvic and acetabular fractures. Patients with pelvic or acetabular fractures were included. Demographic data, fracture classification, time to surgery, and d-dimer levels at admission and one day after surgical intervention were recorded. Duplex ultrasonography was performed in the lower extremities for DVT evaluation. All patients received mechanical and chemical thromboprophylaxis. One hundred ten patients with a mean age of 44.2 ± 13.8 years were included. There were 48 patients with pelvic fractures and 62 patients with acetabular fractures. Thirty-two (29.09%) patients sustained DVT; 21 (19.09%) patients exhibited proximal thrombosis, and 3 patients suffered pulmonary embolism. The incidence of DVT in patients with acetabular fractures was significantly higher than that of patients with pelvic fractures (χ2 = 4.42, P = .04). The incidence of proximal DVT was significantly higher in patients with complex acetabular fractures than in patients with simple acetabular fractures (χ2 = 6.65, P = .01). Multivariate analysis showed that age older than 60 years, associated injuries, and the time to surgery longer than 2 weeks were independent risk factors ( P < .05). Despite mechanical and chemical thromboprophylaxis, the risk of DVT in patients with pelvic and acetabular fractures is still very high, and most of the thromboses were localized proximally. The risk of DVT is higher in patients older than 60 years, in those with associated injuries, and when the time from injury to operation is more than 2 weeks.

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Hyperhomocysteinemia and the compound heterozygous state for methylene tetrahydrofolate reductase are independent risk factors for deep vein thrombosis among South Indians

Blood Coagulation & Fibrinolysis ◽

10.1097/mbc.0b013e3280108e01 ◽

2007 ◽

Vol 18 (2) ◽

pp. 113-117 ◽

Cited By ~ 16

Author(s):

SM Naushad ◽

Md Nurul Jain Jamal ◽

R Angalena ◽

C Krishna Prasad ◽

A Radha Rama Devi

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Compound Heterozygous ◽

Heterozygous State ◽

Vein Thrombosis ◽

Methylene Tetrahydrofolate Reductase ◽

Independent Risk Factors ◽

Methylene Tetrahydrofolate ◽

Deep Vein ◽

Compound Heterozygous State

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THE COURSE OF DEEP VEIN THROMBOSIS OF LOWER LIMBS DEPENDING ON THE CONTENTS OF D-DIMERS AND C-REACTIVE PROTEIN IN THE ACUTE PHASE

Bulletin of Medical Science ◽

10.31684/2542-1336.2019.1(13).57-62 ◽

2019 ◽

pp. 57-62

Author(s):

A.S. Petrikov ◽

D.V. Dudin ◽

L.N. Popkova ◽

I.V. Volodin ◽

Ya.N. Shoikhet

Keyword(s):

Deep Vein Thrombosis ◽

Acute Phase ◽

Lower Limbs ◽

C Reactive Protein ◽

Vein Thrombosis ◽

Reactive Protein ◽

Deep Vein

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Deep Vein Thrombosis in the Uninjured Limb in Patients with Lower Extremity Fractures: A Retrospective Study

BioMed Research International ◽

10.1155/2020/1647617 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Peng-Fei Wang ◽

Jia-Hao Li ◽

Chen Fei ◽

Zhi Li ◽

Chao Ke ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Lower Extremity ◽

Doppler Ultrasonography ◽

Vein Thrombosis ◽

Independent Risk Factors ◽

Level 1 ◽

Deep Vein ◽

Actual Incidence ◽

D Dimer

Objective. This study is aimed at investigating the incidence of deep vein thrombosis (DVT) in the uninjured limb during hospitalization and 1 month after surgery in patients with lower extremity fractures. Methods. We collected the clinical data of patients with lower extremity fractures in Xi’an Honghui Hospital. Doppler ultrasonography was used to diagnose DVT. According to the results of ultrasonography, the patients were divided into two groups: uninjured limb with DVT group and uninjured limb without DVT group. Results. A total of 494 patients who met all inclusion criteria were included in this study. The incidence rate of DVT in the uninjured limb was 19.84% and 18.83% during hospitalization and 1 month after surgery, respectively. Age (OR=1.035, 95% CI: 1.013–1.059; P=0.002) and D-dimer level 1 day after surgery (OR=1.065, 95% CI: 1.030–1.102; P<0.001) were independent risk factors for DVT during hospitalization. Similarly, age (OR=1.045, 95% CI: 1.021–1.070; P<0.001) and D-dimer level 1 day after surgery (OR=1.048, 95% CI: 1.014–1.083; P=0.006) were independent risk factors for DVT 1 month after surgery. During hospitalization and 1 month after surgery, 15.79% and 12.35% of patients had double lower limb thrombosis and 4.04% and 6.48% of patients had DVT in the uninjured limb only, respectively. Conclusion. The actual incidence of DVT in the uninjured limb in patients with lower extremity fractures cannot be ignored despite the use of anticoagulants for prevention or treatment during hospitalization. We should also be aware of DVT in the uninjured limb while focusing on DVT in the injured limb.

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