The effects of location and low-molecular-weight heparin administration on deep vein thrombosis outcomes in trauma patients

Lee, Tim H.; Alonzo, Brock; Differding, Jerome A.; Underwood, Samantha J.; Hamilton, Greg; Kremenevskiy, Igor; McNamara, Steve; Schreiber, Martin A.

doi:10.1097/ta.0b013e31827c5f66

Cited by 16 publications

(13 citation statements)

References 24 publications

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“…Two recent studies indicate that it is. Lee et al 25 showed that above-knee and below-knee DVTs had the same risk of PE (4.7% and 3.3%, respectively, p = 0.59). Olson et al 26 found that below-knee DVT had a higher rate of PE than did above-knee DVT (6.1% and 1.1%, respectively, p = 0.1) and that below-knee DVT propagated to either aboveknee DVT or PE in 12.9%.…”

Section: Discussionmentioning

confidence: 96%

Determining the magnitude of surveillance bias in the assessment of lower extremity deep venous thrombosis

Shackford

Cipolle

Badiee

et al. 2016

Journal of Trauma and Acute Care Surgery

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Section: Discussionmentioning

confidence: 96%

Determining the magnitude of surveillance bias in the assessment of lower extremity deep venous thrombosis

Shackford

Cipolle

Badiee

et al. 2016

Journal of Trauma and Acute Care Surgery

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“…Some authors suggested the risk of proximal DVT was related to the fracture sites that were higher in fractures more proximal to the hip [ 10 , 22 , 23 ]. Anyhow, we did not ignore the role of distal DV, and in some study, it demonstrated to present a similar risk of pulmonary embolism as proximal DVT [ 24 ]. We also observed the relatively few incident DVTs in the bilateral (rate, 5.1%) or even only in uninjured extremity (rate, 2.0%), which was consistent with the previous finding [ 18 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Incidence and locations of deep venous thrombosis of the lower extremity following surgeries of tibial plateau fractures: a prospective cohort study

Zhu

Chen

et al. 2020

J Orthop Surg Res

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Objective To investigate the incidence of deep venous thrombosis (DVT) of the lower extremities following surgeries of tibial plateau fractures. Methods Retrospective analysis of the prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was conducted. Duplex ultrasonography (DUS) was used to screen for postoperative DVT of the bilateral lower extremities. Data on demographics, comorbidities, injury, surgery, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT. Results Among 987 patients included, 46 (4.7%) had postoperative DVT, with incidence rate of 1.0% for proximal and 3.7% for distal DVT. The average interval between operation and DVT was 8.3 days (median, 5.8 days), ranging from 2 to 42 days. DVT involved the injured extremity in 39 (84.8%) patients, both the injured and uninjured extremity in 2 patients (4.3%) and only the uninjured extremity in 5 patients (10.9%). Five risk factors were identified to be associated with postoperative DVT, including age (≥ 41 vs < 41 years) (OR 3.08; 95% CI 1.43–6.61; p = 0.004), anesthesia (general vs regional) (OR 2.08; 95% CI 1.12–3.85; p = 0.021), hyponatremia (OR 2.21; 95% CI 1.21–4.06; p = 0.010), prolonged surgical time (OR 1.04; 95% CI 1.01–1.07; p = 0.017) and elevated D-dimer level (OR 2.79; 95% CI 1.34–4.83; p = 0.004). Conclusion These epidemiologic data may be helpful in individualized assessment, risk stratification, and development of targeted prevention programs.

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“…This is lower than in general orthopaedic surgery where the rate of DVT is reported as 40–60 % [ 23 ], but similar to the incidence of DVT following knee arthroscopy which has been reported as 0.6 % when diagnosed clinically and up to 17.9 % when using radiography [ 31 , 60 ]. The consequences of asymptomatic below knee DVT and the importance of its prevention and treatment remains controversial and a systematic review of the treatment of below knee DVT’s concluded there was insufficient evidence to recommend treatment over mere surveillance [ 8 , 19 , 29 , 34 , 43 , 45 , 58 , 61 , 74 ].…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery

Calder

Freeman

Domeij-Arverud

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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Purpose To perform a meta-analysis investigating venous thromboembolism (VTE) following isolated foot and ankle surgery and propose guidelines for VTE prevention in this group of patients.MethodsFollowing a PRISMA compliant search, 372 papers were identified and meta-analysis performed on 22 papers using the Critical Appraisal Skills Programme and Centre for Evidence-Based Medicine level of evidence.Results 43,381 patients were clinically assessed for VTE and the incidence with and without chemoprophylaxis was 0.6 % (95 % CI 0.4–0.8 %) and 1 % (95 % CI 0.2–1.7 %), respectively. 1666 Patients were assessed radiologically and the incidence of VTE with and without chemoprophylaxis was 12.5 % (95 % CI 6.8–18.2 %) and 10.5 % (95 % CI 5.0–15.9 %), respectively. There was no significant difference in the rates of VTE with or without chemoprophylaxis whether assessed clinically or by radiological criteria. The risk of VTE in those patients with Achilles tendon rupture was greater with a clinical incidence of 7 % (95 % CI 5.5–8.5 %) and radiological incidence of 35.3 % (95 % CI 26.4–44.3 %).ConclusionIsolated foot and ankle surgery has a lower incidence of clinically apparent VTE when compared to general lower limb procedures, and this rate is not significantly reduced using low molecular weight heparin. The incidence of VTE following Achilles tendon rupture is high whether treated surgically or conservatively. With the exception of those with Achilles tendon rupture, routine use of chemical VTE prophylaxis is not justified in those undergoing isolated foot and ankle surgery, but patient-specific risk factors for VTE should be used to assess patients individually.Level of evidenceII.

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The effects of location and low-molecular-weight heparin administration on deep vein thrombosis outcomes in trauma patients

Abstract: Therapeutic study, level IV; epidemiologic study, level III.

Cited by 16 publications

References 24 publications

Determining the magnitude of surveillance bias in the assessment of lower extremity deep venous thrombosis

Determining the magnitude of surveillance bias in the assessment of lower extremity deep venous thrombosis

Incidence and locations of deep venous thrombosis of the lower extremity following surgeries of tibial plateau fractures: a prospective cohort study

Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery

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