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

Wang, Pengfei; Kandemir, Utku; Zhang, Bin-Fei; Wang, Baohui; Li, Jiahao; Zhuang, Yan; Wang, Hu; Zhang, Hong; Liu, Ping; Wang, Pengfei

doi:10.1177/1076029619845066

Cited by 63 publications

(66 citation statements)

References 37 publications

(63 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, although the increase of D-dimer was not found to be an independent risk factor for DVT, the postoperative D-dimer level of the DVT group was significantly higher than that of the non-DVT group, and the D-dimer test of almost all patients was positive. This is consistent with Wang et al’s view that D-dimer detection has poor specificity in trauma patients and its significance is limited [ 32 ]. Neither Tyagi et al nor we found the correlation between intraoperative tourniquet use and DVT, considering that short duration of tourniquet use could not significantly affect the blood status of lower extremities.…”

Section: Discussionsupporting

confidence: 92%

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

Cheng

2020

J Orthop Surg Res

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 92%

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

Cheng

2020

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…This result was not obtained in this study, which may be related to the small sample size and missed diagnosis of doctors in this single center study.Drinking history, advanced age,high-energy trauma, multiple injuries, and comminuted fracture are independent risk factors for DVT. Although these factors cannot be optimized, they are helpful for early identi cation of high-risk groups.D-dimer detection with high sensitivity and low speci city is mostly used to exclude patients with suspected VTE, and its increased level is related to the degree of trauma, fracture site, degree of in ammatory response, pregnancy, etc.In this study, although the increase of D-dimer was not found to be an independent risk factor for DVT, the postoperative d-dimer level of the DVT group was signi cantly higher than that of the non-DVT group, and the D-dimer test of almost all patients was positive.This is consistent with Wang's view that D-dimer detection has poor speci city in trauma patients and its signi cance is limited [28] .Neither Tyagi nor we found the correlation between intraoperative tourniquet use and DVT,considering that short duration of tourniquet use could not signi cantly affect the blood status of lower extremities.But Tyagi still believes that patients with higher VTE risk should consider using a tourniquet during surgery [29] .Whether this simple, low-cost, low-risk intraoperative method can reduce the risk of postoperative DVT remains to be further studied.The results showed that the average preoperative DVT formation was 6.55 ± 0.47 days after the trauma and 6.67 ± 0.48 days after the surgery, which may be related to the peak time of blood hypercoagulability. The d-dimer level reached its peak on the 1st and 7th days after the fracture surgery [30] .This study reviewed the changes in the types of DVT during the perioperative period,54.55% (6/11) complicated with distal thrombosis, 18.18% (2/11) complicated with proximal thrombosis, and 27.27% (3/11) complicated with mixed thrombosis.…”

Section: Discussionsupporting

confidence: 90%

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

Cheng

2020

Preprint

View full text Add to dashboard Cite

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.

show abstract

“…Fractures of extremities are a well-known risk factor for venous thromboembolism. Especially patients suffering from pelvic fractures have a very high risk to develop deep venous thrombosis despite mechanical and pharmaceutical thromboprophylaxis [30]. Consequently, the four AIS subgroups (head, extremities, thorax, abdomen) were chosen to select an adequate number of confounding variables with clinical relevance in regard to the risk of thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Impact of a goal-directed factor-based coagulation management on thromboembolic events following major trauma

Stein

Rössler

Braun

et al. 2019

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background: A factor-based coagulation management following major trauma is recommended as standard of care by the European Trauma Treatment Guidelines. However, concerns about the thromboembolic risk of this approach are still prevalent. Our study therefore aims to assess if such a haemostatic management is associated with an increased risk for thromboembolic events. Methods: In this retrospective observational study carried out at the University Hospital Zurich we compared two three-year periods before (period 1: 2005-2007) and after (period 2: 2012-2014) implementation of a factor-based coagulation algorithm. We included all adult patients following major trauma primarily admitted to the University Hospital Zurich. Thromboembolic events were defined as a new in-hospital appearance of any peripheral thrombosis, arterial embolism, pulmonary embolism, stroke or myocardial infarction. A logistic regression was performed to investigate the association of thromboembolic events with possible confounders such as age, sex, specific Abbreviated Injury Scale (AIS) subgroups, allogeneic blood products, and the coagulation management. Results: Out of 1138 patients, 772 met the inclusion criteria: 344 patients in period 1 and 428 patients in period 2. Thromboembolic events were present in 25 patients (7.3%) of period 1 and in 42 patients (9.8%) of period 2 (raw OR 1.39, 95% CI 0.83 to 2.33, p = 0.21). Only AIS extremities (adjusted OR 1.26, 95% CI 1.05 to 1.52, p = 0.015) and exposure to allogeneic blood products (adjusted OR 2.39, 95% CI 1.33 to 4.30, p = 0.004) were independently associated with thromboembolic events in the logistic regression, but the factor-based coagulation management was not (adjusted OR 1.60, 95% CI 0.90-2.86, p = 0.11). Conclusion: There is no evidence that a goal-directed, factor-based coagulation management is associated with an increased risk for thromboembolic events following major trauma.

show abstract

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

Cited by 63 publications

References 37 publications

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

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

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

Impact of a goal-directed factor-based coagulation management on thromboembolic events following major trauma

Contact Info

Product

Resources

About