A Retrospective cohort study on the risk factors of deep vein thrombosis (DVT) for patients with traumatic fracture at Honghui Hospital

Abstract

ObjectiveTo explore the risk factors of perioperative deep vein thrombosis (DVT) in patients with traumatic fracture after orthopaedic surgery and their potential diagnostic values in clinical.DesignRetrospective cohort study.SettingClinical Laboratory of Honghui Hospital, Xi’an JiaoTong University College of Medicine, Xi’an, Shaanxi, China.Materials and methodsA retrospective cohort study was conducted with surgically treated fracture patients in Honghui Hospital from 1 May 2016 to 31 February 2017.χ2test, independent sample t test and regression analysis were applied to examine the correlation between perioperative DVT and the factors of preoperative time, fracture sites, D-dimer value and chronic diseases (hypertension, diabetes and coronary disease).Results462 patients were enrolled for analysis. The preoperative time of patients with DVT was significantly longer than that of non-DVT patients (7.14±5.51 vs 5.45±3.75) (P<0.01).χ2test showed the significant differences in the rate of DVT among patients with different fracture sites (P<0.01). By the receiver-operating characteristic curve analysis, the cut-off value of preoperative D-dimer and postoperative D-dimer in diagnosing perioperative DVT was 4.01 µg/mL and 5.03 µg/mL, respectively. Area under the curve was 0.593 (95% CI 0.533 to 0.652) and 0.728 (95% CI 0.672 to 0.780), respectively. The sensitivity and specificity of preoperative D-dimer for DVT diagnosis were 71.30% and 44.83%, and as for postoperative D-dimer were 63.90% and 70.51%.ConclusionsFracture site was correlated to the incidence of DVT; prolonged preoperative time and increased D-dimer value were independent risk factors for DVT in patients with lower extremity traumatic fractures.

Study on the Risk Factors of Deep Vein Thrombosis (DVT) in Patients With Lower Extremity Fracture

“…Therefore, an increased D-dimer content in plasma indicates the occurrence of thrombosis and dissolution in vivo, and can therefore be used as an indicator of non-invasive thrombosis [23] . The results of the present study demonstrated that the plasma D-dimer level is an independent factor that affects the formation of DVT, which is similar to the results of Zhang et al [9] . However, the D-dimer level increases with age and elderly patients are more prone to false-positive test results, which reduces the speci city of detection in these patients; therefore, studies have demonstrated the need to set the best cut-off value according to age to increase the speci city of detection [24] .…”

“…However, long-term bed rest leads to reduced muscle pumping, severe local blood ow stagnation, and serious vascular endothelial injury. Moreover, the accumulation of coagulation factors leads to the overactivation of the coagulation system, thereby leading to accelerated thrombosis [9,[13][14][15] . However, once the venous thrombosis of lower extremities is formed, due to changes in the body position or local massage factors, the thrombosis tends to fall off and form fatal PE; it has been reported that 10% of patients with DVT develop fatal PE [16] .…”

“…Peri-hip fractures are more common in older patients, and many patients with these fractures choose arthroplasty surgery; this is one of the reasons for the high incidence of DVT following peri-hip fractures [8] . Some researchers have also con rmed that hip fracture is an important risk factor for, and is signi cantly associated with, the occurrence of DVT [9] . However, in the present study, patients with periknee fractures had the highest prevalence at 9.7%.…”

“…In a study involving 829 patients, the incidences of DVT in patients with hip, femur shaft, knee, lower leg, and foot or ankle fractures were found to be 16.7%, 12.2%, 9%, 3.7%, and 2.3%, respectively [8] . In another study of 462 patients, 71.2% of patients with DVT had hip fractures, 11.9% had tibio bular fractures, and 10.4% had femoral shaft fractures [9] . These ndings indicate that the hip fracture group had the highest incidence of DVT.…”

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

“…Among fracture patients, the current routine anticoagulant regimens are used for the prevention and treatment of DVT in patients with different risks, which does not change the current situation that the incidence of DVT is still relatively high.It is particularly important to further clarify independent risk factors for DVT to identify high risk groups.The occurrence of DVT was signi cantly correlated with the fracture site. Similar to the results of Adam and Zhang [12,13] , the incidence of hip fracture (74.90%) was relatively high. Considering that the three risk factors of Virchow were mostly present in the patients with hip fracture [14] .We should pay attention to the screening of DVT in these patients with fractures at speci c sites, and formulate reasonable individualized prevention and treatment strategies.Meizoso et al used RAP score in a retrospective cohort study of 1233 trauma patients and found that transfusion of more than 4 units was an independent risk factor for DVT [15] .The preoperative, intraoperative and postoperative blood transfusion rates of 569 patients in this study were 8.44% (48/569), 29.70% (169/569), and 13.88% (79/569), respectively.It was further found that intraoperative blood transfusion and postoperative blood transfusion were independent risk factors for postoperative DVT, while preoperative blood transfusion was not correlated with DVT.Perhaps we should reconsider the indications and necessity of blood transfusion in practice.Song et al reported that most patients with postoperative DVT had complicated DVT before surgery [16] ,In this study, preoperative DVT occurred in 26.71% of the patients, which was considered to be related to the longer average preoperative waiting time.Most of the current recommendations are that surgery should be performed as soon as possible within 48 hours after trauma to reduce the incidence of VTE [17] .But in practice, 66 percent of patients with hip fractures delayed surgery [18] .The reasons for delayed surgery may be as follows.…”