Venous thromboembolism after major venous injuries: Competing priorities

Frank, Brian; Maher, Zoë; Hazelton, Joshua P.; Resnick, Shelby; Dauer, Elizabeth; Goldenberg, Anna; Lubitz, Andrea L.; Smith, Brian P.; Saillant, Noelle; Reilly, Patrick; Seamon, Mark J.

doi:10.1097/ta.0000000000001655

Cited by 28 publications

(32 citation statements)

References 38 publications

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“…However, long-term bed rest leads to reduced muscle pumping, severe local blood ow stagnation, and serious vascular endothelial injury. Moreover, the accumulation of coagulation factors leads to the overactivation of the coagulation system, thereby leading to accelerated thrombosis [9,[13][14][15] . However, once the venous thrombosis of lower extremities is formed, due to changes in the body position or local massage factors, the thrombosis tends to fall off and form fatal PE; it has been reported that 10% of patients with DVT develop fatal PE [16] .…”

Section: Discussionmentioning

confidence: 99%

Study on the Risk Factors of Deep Vein Thrombosis (DVT) in Patients With Lower Extremity Fracture

Chang

Wang

et al. 2020

Preprint

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Abstract Background:The objective of this work is to discuss and analyze the related factors of lower extremity fracture complicated by deep vein thrombosis (DVT), and to help surgeons aptly prevent it.Methods:A retrospective analysis was conducted on the orthopedic inpatient records of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from July 2014 to November 2018, and 11,891 patients with closed fractures of lower extremities were selected.By analyzing each patient's gender, age, presence or absence of diabetes and hypertension,preoperative plasma D-dimer level, and color Doppler ultrasound of the lower extremity vein, the pertinent factors of the patients with lower extremity fractures complicated by DVT were analyzed.Results: A total of 11,891 patients were selected, including 4462 with cases of peri-hip fractures, 754with cases of femoral shaft fractures, 1776 with cases of peri-knee fractures, 1961 with cases of tibiofibular fractures, and 2938 with cases of ankle fractures.Of these patients, 643 with DVT were detected, displaying a total incidence of 5.4%.All patients were categorized into either the DVT group or non-DVT group.The results demonstrate that there were statistically significant differences between the two groups in age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level (p<0.05), but there was no statistically significant difference in sex (p>0.05). Logistic multivariate analysis revealed that age, the presence of diabetes, and the preoperative plasma D-dimer level of patients were independent risk factors for lower extremity fracture complicated by DVT.Conclusion: Age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level were found to be correlated with the incidence of DVT. Moreover,age, the presence of diabetes, the preoperative fracture site, and the plasma D-dimer level were found to be independent risk factors.

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Section: Discussionmentioning

confidence: 99%

Study on the Risk Factors of Deep Vein Thrombosis (DVT) in Patients With Lower Extremity Fracture

Chang

Wang

et al. 2020

Preprint

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“…Moreover, the studies looked at a range of different locations that were affected by the trauma. There were 4 studies that exclusively looked at lower limb trauma [20][21][22][23] whilst 3 looked at both upper and lower [24][25][26]. However, one study did not make clear distinctions between anatomical locations of the traumatic insult [27].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…It would appear that the majority of studies looked at included patients suffering from vascular trauma alongside associated fractures although in some studies, it was difficult to determine the exact injuries. However, in two of the studies, they included patients suffering from head injuries with vascular trauma and fractures [21,24] but it is unclear if there was a difference in treatment protocol and outcomes with these patients alone. Notably, there were no identifiable studies on the effect of solely administering anti-platelet therapy on the outcomes of vascular trauma surgery.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Notably, there were no identifiable studies on the effect of solely administering anti-platelet therapy on the outcomes of vascular trauma surgery. Seven studies reported the use of anticoagulation alone in patients with vascular trauma [20,21,[23][24][25][26][27] and one study reported the effects of anticoagulation and antiplatelet (aspirin) therapy in this context [22]. No studies looking at the use of anti-platelets alone were found.…”

Section: Study Characteristicsmentioning

confidence: 99%

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A meta-analysis on anticoagulation after vascular trauma

Khan

Elghazaly

Mian

et al. 2020

Eur J Trauma Emerg Surg

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Purpose There is much debate regarding the use of anticoagulation following vascular trauma. The aim of this meta-analysis was to compare the outcome of trauma following administration of anticoagulation medication. Methods The literature search was carried out using Ovid MEDLINE and PubMed databases to search for keywords and MeSH terms including "Anticoagulation", "Vascular Surgery", "Vascular Trauma", "Vascular Repair", "Repair" and "Wounds and Injuries". Results Use of anticoagulation was associated with a better prognosis for overall vascular trauma outcomes (weighted OR 0.46; 95% CI 0.34-0.64; P < 0.00001), as well as reduced risk of amputation for both lower and upper limb vascular trauma (weighted OR 0.42; 95% CI 0.22-0.78; P = 0.007), and reduced occurrence of reoperation events and amputations in isolated lower limb vascular trauma (weighted OR 0.27; 95% CI 0.14-0.52; P < 0.0001). Conclusion There was a statistically significant correlation between the use of anticoagulation and vascular trauma outcome. A major limitation with many of the studies includes a lack of prospective analysis and therefore we recommend prospective studies to properly elucidate prognostic outcomes following use of these anticoagulants. Further studies need to be conducted to assess the effects of timing of anticoagulant delivery, dosages and severity of traumatic injury. Thus, this would prove to be very useful in the formation of guidelines.

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“…The National Trauma Data Bank (NTDB) has the benefit of a large sample size of >4 million patient records from >700 facilities, representing every type of trauma center from large to small, and is the largest aggregation of U.S. and Canadian trauma registry data available. 2 This benefit is inherently balanced by its lack of granularity of the data. The NTDB does not provide data about intraoperative anticoagulation.…”

Section: Replymentioning

confidence: 99%