Risk factors of postoperative deep vein thrombosis (DVT) under low molecular weight heparin (LMWH) prophylaxis in patients with thoracolumbar fractures caused by high-energy injuries

Wang, Haiying; Pei, Honglei; Ding, Wenyuan; Yang, Dalong; Ma, Lei

doi:10.1007/s11239-020-02192-7

Cited by 19 publications

(21 citation statements)

References 32 publications

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“…Six variables were determined to be independent risk factors for DVT. These six variables included age category (> 65 years old), OR, 4 2). Hosmer and Lemeshow test revealed good fitness of the final model (p = 0.727).…”

Section: Resultsmentioning

confidence: 99%

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Incidence and risk factors for deep venous thrombosis of lower extremity after surgical treatment of isolated patella fractures

Tan

Deng

et al. 2021

J Orthop Surg Res

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Background Limited information exists on the incidence of postoperative deep venous thromboembolism (DVT) in patients with isolated patella fractures. The objective of this study was to investigate the postoperative incidence and locations of deep venous thrombosis (DVT) of the lower extremity in patients who underwent isolated patella fractures and identify the associated risk factors. Methods Medical data of 716 hospitalized patients was collected. The patients had acute isolated patella fractures and were admitted at the 3rd Hospital of Hebei Medical University between January 1, 2016, and February 31, 2019. All patients met the inclusion criteria. Medical data was collected using the inpatient record system, which included the patient demographics, patient’s bad hobbies, comorbidities, past medical history, fracture and surgery-related factors, hematological biomarkers, total hospital stay, and preoperative stay. Doppler examination was conducted for the diagnosis of DVT. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Results Among the 716 patients, DVT was confirmed in 29 cases, indicating an incidence of 4.1%. DVT involved bilateral limbs (injured and uninjured) in one patient (3.4%). DVT involved superficial femoral common vein in 1 case (3.4%), popliteal vein in 6 cases (20.7%), posterior tibial vein in 11 cases (37.9%), and peroneal vein in 11 cases (37.9%). The median of the interval between surgery and diagnosis of DVT was 4.0 days (range, 1.0-8.0 days). Six variables were identified to be independent risk factors for DVT which included age category (> 65 years old), OR, 4.44 (1.34-14.71); arrhythmia, OR, 4.41 (1.20-16.15); intra-operative blood loss, OR, 1.01 (1.00-1.02); preoperative stay (delay of each day), OR, 1.43 (1.15-1.78); surgical duration, OR, 1.04 (1.03-1.06); LDL-C (> 3.37 mmol/L), OR, 2.98 (1.14-7.76). Conclusion Incidence of postoperative DVT in patients with isolated patella fractures is substantial. More attentions should be paid on postoperative DVT prophylaxis in patients with isolated patella fractures. Identification of associated risk factors can help clinicians recognize the risk population, assess the risk of DVT, and develop personalized prophylaxis strategies.

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Section: Resultsmentioning

confidence: 99%

“…Researchers have investigated the occurrence of DVT in patients who had undergone orthopedic major surgeries [1]. Authors have studied DVT after major orthopedic trauma such as hip fractures [2], pelvicacetabular fractures [3], and spinal fractures [4]. The association between trauma and DVT is well recognized [5].…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors for deep venous thrombosis of lower extremity after surgical treatment of isolated patella fractures

Tan

Deng

et al. 2021

J Orthop Surg Res

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“…Our previous study found that in patients with thoracolumbar fractures caused by high-energy injuries, D-dimer at admission was a risk factor for DVT, but the AUC value was not very high. 26 So in the present study, we measured the D-dimer level at 1 day before surgery and on the first, third, and fifth days postoperatively to detect the early changes of D-dimer levels.…”

Section: Discussionmentioning

confidence: 99%

The Impact of D-Dimer on Postoperative Deep Vein Thrombosis in Patients with Thoracolumbar Fracture Caused by High-Energy Injuries

Wang

et al. 2022

Clin Appl Thromb Hemost

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Objective To investigate the dynamic variation of D-dimer and to evaluate the efficacy and accuracy of D-dimer level in patients with thoracolumbar fractures caused by high-energy injuries. Methods A total of 121 patients with thoracolumbar fractures caused by high-energy injuries were retrospectively identified and included in this study. There were 83 males and 38 females, with an average age of 48.6 ± 11.2 years. All patients were treated with either screw fixation surgery or decompression fixation surgery. The D-dimer levels were measured 1 day before surgery and on the first, third, and fifth days after surgery. The dynamic variation of D-dimer and the effects of risk factors on D-dimer levels were analysed. A receiver operating characteristic (ROC) curve analysis was performed and the appropriate D-dimer cut-off level was determined for deep vein thrombosis (DVT) screening. Results Due to a trough on the third day, D-dimer levels grew in an unsustainable manner following surgery (P < 0.001). Patients with the operation time >120 min (P = 0.009) and those with an American Spinal Injury Association (ASIA) score A-C (P < 0.001) had higher D-dimer levels. The area under the curve of D-dimer was the greatest on the third day. Applying stratified cut-off values did not change the sensitivity, specificity and negative predictive value in the group with an operation time >120 min, and ASIA score A-C group. Conclusions D-dimer levels elevated with fluctuation in patients with thoracolumbar fractures caused by high-energy injuries after surgery. Both operation time and ASIA score had an impact on D-dimer levels. Regarding DVT diagnoses, the diagnostic value of D-dimer was highest on the third day postoperatively, and stratified cut-off values by these two factors did not show better diagnostic efficacy compared with a collective one.

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“…[7][8][9] The meta-analysis also did not include trauma surgery, another patient population at higher risk of VTE in need of its own specific analysis to determine chemoprophylactic timing. 10 The root of the problem may be attempting to find a unifying consensus among such a large heterogeneous group in the first place rather than investigating patient and surgical specific risk factors and outcomes. Appropriately, the authors performed a sub-group analysis on orthopedic operations compared to non-orthopedic and found the absolute rate of VTE orthopedic operations was approximately 7 times greater than those undergoing non-orthopedic operations.…”

Section: Mcalpine Et Al Account For the Significant Heterogeneity That Exists Among The Pooledmentioning

confidence: 99%

Surgical Venous Thromboembolism (VTE) Chemoprophylaxis Timing: An Issue of Heterogeneity

Welker

Ramakrishna

2022

Journal of Cardiothoracic and Vascular Anesthesia

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Risk factors of postoperative deep vein thrombosis (DVT) under low molecular weight heparin (LMWH) prophylaxis in patients with thoracolumbar fractures caused by high-energy injuries

Cited by 19 publications

References 32 publications

Incidence and risk factors for deep venous thrombosis of lower extremity after surgical treatment of isolated patella fractures

Incidence and risk factors for deep venous thrombosis of lower extremity after surgical treatment of isolated patella fractures

The Impact of D-Dimer on Postoperative Deep Vein Thrombosis in Patients with Thoracolumbar Fracture Caused by High-Energy Injuries

Surgical Venous Thromboembolism (VTE) Chemoprophylaxis Timing: An Issue of Heterogeneity

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