Hubungan dan titik potong skor Caprini terhadap D-dimer sebagai parameter resiko trombosis vena dalam pada pasien paska fiksasi internal fraktur tulang panjang ekstremitas bawah

Abstract

Background: Fractures contribute to a substantial proportion of the emergency department cases. Surgical procedures such as internal fixation of lower limb fractures posed a risk to develop deep vein thrombosis (DVT). The current diagnosis of DVT is still a challenge, as the current main parameter, the D-dimer, requires additional laboratory time and cost. Threrefore, an easier and faster alternative should be used in clinical decision making. Caprini score is among a simple method to assess the risk of a DVT, but validation is still needed before it can be implemented.Methods: This is an cross-sectional analytic study aimed to determine the relationship between Caprini scores and D-dimer level in patients with post-internal fixation of long bone fractures in lower extrimities at Sanglah Hospital Denpasar. Caprini scores were determined before surgery then D-dimer measurements were taken postoperatively. Statistical analysis was performed using the Pearson correlation method and ROC curve were generated to determine the cut-off point of Caprini Score equivalent of high risk DVT with the D-dimer as the predictor.Result: The average Caprini score was 9.37 (7-13). Mean preoperative D-dimer was 6.59 µg/ml (2.50-13.20 µg/ml), postoperatively 11.50 µg / ml (3.71-19.89 µg/ml) and mean delta D -Dimer 5.23 µg/ml (0.56-12.28 µg/ml). Pearson correlation test obtained a strong positive relationship (r = 0.726 and p≤0,0001). Analysis of the ROC curve to determine the cut-off point for Caprini score which equivalent to the high risk of DVT from D-dimer prediction (> 7.2 µg / ml) resulted in AUC of 0.824 (95% CI 0.669-0.979, p= 0.024) with the optimal cut-off point for Caprini score was 8.Conclusion: Caprini and D-dimer scores show a strong positive correlation. Caprini scores can be considered to estimate the risk of DVT in post-internal fixation patients of lower extremities long bone fractures. Latar Belakang. Kejadian fraktur memiliki proporsi yang substansial dari total pasien yang datang ke unit gawat darurat rumah sakit. Prosedur operasi seperti pemasangan fiksasi internal pada fraktur ekstremitas bawah memiliki resiko untuk terjadinya trombosis vena dalam (DVT). Penegakan diagnosis DVT saat ini masih merupakan suatu tantangan salah satunya karena pemeriksaan laboratorium D-dimer membutuhkan waktu dan biaya tambahan, sehingga dibutuhkan alternatif yang lebih mudah dan cepat digunakan dalam pengambilan keputusan klinis. Skor Caprini merupakan salah satu cara untuk menilai resiko terjadinya suatu DVT, akan tetapi masih diperlukan validasi sebelum dapat diimplementasikan. Metode: Penelitian cross-sectional analitik dilakukan untuk mengetahui hubungan Skor Caprini dengan kadar D-dimer pada pasien paska operasi fiksasi internal fraktur tulang panjang ekstremitas bawah di RSUP Sanglah Denpasar. Skor Caprini ditentuakan sebelum operasi kemudian pengukuran D-dimer dilakukan paska operasi. Analisis statistik dilakukan dengan metode korelasi Pearson dan penentan titik potong risiko DVT dengan prediktor D-dimer menggunakan metode kurva ROC.Hasil: Rerata Skor Caprini adalah 9,37 dengan rentang skor 7-13. Rerata D-dimer sebelum operasi sebesar 6,59 µg/ml (2,50-13,20 µg/ml), paska operasi 11,50 µg/ml (3,71-19,89 µg/ml) dan rerata delta D-Dimer 5,23µg/ml (0,56-12,28 µg/ml). Uji korelasi Pearson diperoleh hubungan positif kuat antara Skor Caprini dengan kadar D-dimer (nilai r=0,726 dan nilai p≤0,0001). Analisis kurva ROC untuk menentukan itik potong  Skor Caprini yang setara dengan resiko tinggi terjadinya DVT dari prediksi D-dimer (>7,2 µg/ml) memperoleh Area Under Curve 0,824 (95% CI 0,669-0,979, p = 0,024) dengan titik potong optimal skor Caprini 8.Kesimpulan: Skor Caprini dan D-dimer menunjukkan korelasi positif yang kuat pada pasien paska fiksasi internal fraktur tulang panjang ekstremitas bawah. Skor Caprini dapat dipertimbangkan sebagai acuan dalam menentukan resiko terjadinya DVT.

High D-dimer Level in Fracture Patient with Asymptomatic Covid-19: Dilemmatic Surgery Decision - A Serial Case Report

“…The other study, Wirabhawa et al showed there is a positive relationship between the Caprini Score and D-Dimer with cut-off point Caprini score of 8 is equivalent to D-dimer >7.2 ug/ml as predictor of DVT risk in post-fixation patients internal fractures of the long bones of the lower extremities. 6 Pannuci et al also show that the benefit thromboprophylaxis only shown in surgical patients with Caprini score above seven points. 13 Appropiate medication with individualized VTE risk grouping helps determine the thromboprophylaxis is done in exact surgical patients and might decrease complications.…”

“…It was more sensitive in able to identify patients who needed prophylaxis. 6 Identification involves a potential risk of bleeding and implementation of risk assessment models (RAM) are essensial to ensure correct use of thromboprophylaxis such as IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) bleeding risk score.…”