Early Detection of Deep Venous Thrombosis in Trauma Patients

Nielsen, Stanton; O’Connor, David; Kaul, Sanjeev; Sharma, Jyoti; Napolitano, Massimo; Simonian, Gregory; Blatt, Melissa; Zielonka, Tania; Nyirenda, Themba; Cohn, Stephen M.

doi:10.7759/cureus.9370

Cited by 5 publications

(4 citation statements)

References 26 publications

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“…The three main factors leading to venous thrombosis are endothelial lesions, venous stasis, and blood hypercoagulation. In trauma patients, endothelial damage and coagulation disorders caused by trauma and slow blood flow caused by braking or bed rest increased the risk of VTE ( 13 ). VTE is also a prominent contributing factor to mortality among trauma patients ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

High fibrinogen and mixed proximal and distal thrombosis are associated with the risk of residual venous thrombosis in patients with posttraumatic deep vein thrombosis

Liu

Deng²,

Zhu³

et al. 2023

Front. Cardiovasc. Med.

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BackgroundThe risk factors for residual venous thrombosis (RVT) in patients with post-trauma deep vein thrombosis (DVT) are unknown.MethodsWe evaluated 127 patients with DVT after trauma, all of whom were treated with conventional anticoagulation and assessed for the presence of RVT with venous compression ultrasound (CUS), using an internal diameter of the venous lumen ≥ 4 mm after compression as the criterion.ResultsRVT was present in 59 (46%) patients, and complete thrombus dissolution was present in 68 (54%) patients. Among them, mixed proximal and distal thrombosis (OR, 4.292; 95% CI, 1.253–14.707), diabetes (OR, 6.345; 95% CI, 1.125–35.786), fibrinogen > 4.145 g/L (OR, 2.858; 95% CI, 1.034–7.897), the time between detection of thrombus and initiation of antithrombotic therapy > 2.5 days (OR, 3.470; 95% CI, 1.085–11.094) was an independent risk factor for RVT in patients with posttraumatic DVT.ConclusionA mixed proximal and distal thrombosis, diabetes mellitus, late initiation of antithrombotic therapy, and high fibrinogen levels increase the risk of RVT in patients with posttraumatic DVT. Therefore, treatment regimens for patients with posttraumatic DVT can be adjusted according to the site of thrombosis, the presence of diabetes mellitus, and the level of fibrinogen, and antithrombotic therapy can be started as early as possible after the detection of thrombosis to prevent the development of RVT and its serious complications.

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Section: Discussionmentioning

confidence: 99%

High fibrinogen and mixed proximal and distal thrombosis are associated with the risk of residual venous thrombosis in patients with posttraumatic deep vein thrombosis

Liu

Deng²,

Zhu³

et al. 2023

Front. Cardiovasc. Med.

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“…Active and effective prevention and care measures are the key to clinical prevention and treatment of DVT. In modern medicine, there are higher requirements for the quality of services, not only to have better treatments, but also to strengthen nursing interventions, which requires clinical nursing to strengthen management measures (31). The application of PDCA in the nursing care of critically ill neurosurgical patients can change the traditional modes of working.…”

Section: Discussionmentioning

confidence: 99%

Effect of plan-do-check-active method combined with air pressure wave therapy on the prevention of deep venous thrombosis in critically ill patients in neurosurgery

Li¹,

Liang²,

Li³

et al. 2023

Ann Palliat Med

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Background: Deep vein thrombosis (DVT) is prone to occur in the recovery of critically ill neurosurgical patients, increasing economic and psychological pressure, and even endangering life. Plan-Do-Check-Action (PDCA) cycle is a kind of quality management cycle procedure, which can help DVT treatment correctly understand the cause of disease and take effective preventive and nursing measures. The air wave pressure therapy instrument takes pressure therapy as the core, forming circulating pressure on limbs and tissues, promoting the flow of blood and lymph, improving the effect of microcirculation, accelerating the return of limb tissue fluid, and preventing thrombosis and limb edema.Methods: A total of 98 critical neurosurgery patients were selected as the study subjects. On the basis of PDCA circulation treatment, the patients were treated with air pressure wave for 30 minutes/time, twice/day and 14 days. Before and after treatment, the indexes of coagulation function, hemorheology (plasma viscosity, whole blood high shear viscosity and whole blood low shear viscosity), lower limb circumference (15 cm above and below the patella) and Barthel index (BI) scores were observed and recorded. DVT was observed by vascular Doppler ultrasound before and after treatment, and the incidence was calculated.Results: The prothrombin time (18.09 s) and thrombin time (17.66 s) after treatment were higher than those before treatment (12.98 s, 130.7 s), and fibrinogen decreased (4.21 vs. 3.31 g/L). The hemorheological indexes of the patients after treatment were plasma viscosity (1.49 mPa/s, 10.8 mPa/s), whole blood high shear viscosity (6.34 mPa/s, 4.47 mPa/s), whole blood low shear viscosity (9.89 mPa/s, 6.32 mPa/s), circumference at 15 cm below the patella (52.29 cm, 45.23 cm), and circumference at 15 cm above the patella (36.17 cm, 31.38 cm). The BI score showed that the number of patients with severe dependence on grade A (46/15) and moderate dependence on grade B (50/14) decreased after treatment, and the average BI score of patients with combined treatment increased (43.87 and 79.86). After treatment, the number of patients with DVT (20/4) and the incidence of DVT (20.40816327%, 4.081632653%) decreased significantly (P<0.05).Conclusions: PDCA circulation combined with barometric wave therapy can significantly improve DVT in critical neurosurgical patients.

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“…Following traumatic injury has been associated with the development of venous thromboembolism in up to 58% of victims [137], although the incidence varies with time [138]. Despite platelet hyporeactivity in the initial phase, restoration of platelet function may trigger rebound hyperaggregation and hypercoagulation [133] potentially leading to development of DVT [22,25,139].…”

Section: Vascular Thrombosismentioning

confidence: 99%

Interplay between Platelet Dysfunction and Vascular Thrombosis in Traumatic Injury

Ogweno¹,

Murungi²

2023

Microcirculation - Updates in the Next Frontier of Vascular Disease

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Platelets halt bleeding accompanying traumatic injury by performing primary hemostasis to repair vascular leakage at injury sites. In trauma individuals, ex vivo platelet function tests often indicate impairment despite normal count. Moreover, incubation of platelets from normal non-traumatized individuals with plasma from trauma victims demonstrates impairment suggesting association with factors in circulation. Notably, not all trauma victims die from hemorrhage. Despite laboratory evidence of dysfunction, thrombotic vascular occlusions are persistent in trauma survivors as corroborated by postmortem findings from victims who die. The time course of platelet reactions post-traumatic injury, that is, the transition from states favoring bleeding to those that facilitate thrombosis is still unclear. Of the several terminologies describing platelet behavior with regards to injury, including hyporeactivity, anergy, exhaustion, and maladaptive states, few have focused on platelet-platelet interactions. It is increasingly becoming clear that platelet interaction with injured endothelium is a probable missing link in the mechanistic explanation of vascular thrombosis post-traumatic injury. This postulate is supported by evidence of increased adhesive protein, von Willebrand factor, and released from injured endothelium. In all, this potentially explains the suboptimal response to anticoagulants or antiplatelets post-trauma. This chapter will review current knowledge on platelet functions in relation to vascular thrombosis post-trauma, the time course, mechanistic hypothesis, and response to therapeutic interventions and clinical outcomes.

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Early Detection of Deep Venous Thrombosis in Trauma Patients

Cited by 5 publications

References 26 publications

High fibrinogen and mixed proximal and distal thrombosis are associated with the risk of residual venous thrombosis in patients with posttraumatic deep vein thrombosis

High fibrinogen and mixed proximal and distal thrombosis are associated with the risk of residual venous thrombosis in patients with posttraumatic deep vein thrombosis

Effect of plan-do-check-active method combined with air pressure wave therapy on the prevention of deep venous thrombosis in critically ill patients in neurosurgery

Interplay between Platelet Dysfunction and Vascular Thrombosis in Traumatic Injury

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