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%, 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.

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

“…The incidence of DVT in pelvic fractures is reported to range from 3% 6 to 23%, 7 even 43.28%, 8 in recent studies. However, previous studies only focused on the percentage of DVT, not detailed analysis of DVTs from pelvic fracture.…”

Risk factors for deep vein thrombosis after traumatic lower extremity fracture: A systematic review and meta-analysis

“…We excluded another 121 studies based on inclusion and exclusion criteria. Finally, a total of 13 studies [8][9][10][11][12][13][14][15][16][17][18][19][20] were included in this meta-analysis. The literature screening process is shown in Figure 1.…”

“…The 13 included literatures [8][9][10][11][12][13][14][15][16][17][18][19][20] are all original studies. This included 2699 VTE patients and 130,507 normal healthy controls.…”

“…Wahlsten et al [8] 2015 Denmark Cohort 594 57,025 Mantilla et al [9] 2003 USA Case-control 116 Yang [10] 2010 China Case-control 58 Akpinar et al [11] 2013 Turkey Case-control 55 Pedersen et al [12] 2010 Denmark Case-control 1390 66,079 Park et al [13] 2015 Korea Cohort 38 Riou et al [14] 2007 France Case-control 178 Gu [15] 2007 China Case-control 18 Wang [16] 2013 China Case-control 52 Long [17] 2013 China Case-control 73 Tan Z et al [18] 2021 China Case-control 29 Ding K et al [19] 2022 China Case-control 51 Peng J et al [20] 2023 China Case-control 47 traumatic fracture of lower extremity (RR = 1.67, 95% CI: 1.56-1.79), as shown in Figure 5.…”

“…Wahlsten et al [8] 9 Good Good Clarity Good Good Low risk Long Good Mantilla et al [9] 8 Good Good Uncertainty Clarity Good Low risk Long Good Yang [10] 6 Uncertainty Good Clarity Uncertainty Uncertainty Low risk Long Good Akpinar et al [11] 8 Good Good Clarity Clarity Uncertainty Low risk Long Good Pedersen et al [12] 7 Uncertainty Good Clarity Clarity Uncertainty Low risk Long Good Park et al [13] 7 Good Uncertainty Clarity Clarity Good Low risk Long Uncertainty Riou et al [14] 5 Good -Clarity -Uncertainty Low risk Long Uncertainty Gu [15] 6 Good -Clarity -Uncertainty Low risk Long Good Wang [16] 9 Good Good Clarity Clarity Uncertainty Low risk Long Good Long [17] 6 Good -Clarity -Uncertainty Low risk Long Good Tan Z et al [18] 7 Good -Clarity Clarity Uncertainty Low risk Long Good Ding K et al [19] 6 Uncertainty Good Clarity Clarity Uncertainty Low risk Long Good Peng J et al [20] 7 Uncertainty Good Clarity Clarity Uncertainty Low risk Long Good NOS = Newcastle-Ottawa Scale. fractures and LEDVT after fracture, and single-site fractures were protective factors for LEDVT after traumatic fracture (RR = 0.52, 95% CI: 0.39-0.64), as shown in Figure 10.…”