Clinical Predictive Factors of Lower Extremity Deep Vein Thrombosis in Relative High-Risk Patients after Neurosurgery: A Retrospective Study

Abstract

Introduction. It is acknowledged that patients undergoing neurosurgery with neurological illness are at higher risk of lower extremity deep vein thrombosis (DVT). As an underlying life-threatening complication, the incidence and risk factors for high-risk patients with lower extremity deep vein thrombosis are still controversial in relative high-risk patients after neurosurgery. Materials and Methods. A total of 204 patients who underwent neurosurgery and were considered as a high-risk group of DVT according to times of stay in bed more than 3 days were enrolled in this study. We evaluated the lower extremity DVT by using Color Doppler Ultrasound System (CDUS). Clinical parameters of patients at the time of admission and postoperation were recorded and prepared for further analysis. Early predictive factors for postoperative lower extremity DVT were established. Diagnostic performance of predictive factors was evaluated by using receiver operating characteristic (ROC) curve analysis. Results. The overall incidence rate of DVT in 204 enrolled patients was 30.9%. Multivariate logistic regression indicated that hypertension (OR 3.159, 95% CI 1.465-6.816; P=0.003), higher postoperative D-dimer (OR 1.225, 95% CI 1.016-1.477; P=0.034), female (OR 0.174, 95% CI 0.054-0.568; P=0.004), and lower GCS score (OR 0.809, 95% CI 0.679-0.965; P=0.013) were independently associated with incidence of DVT in patients after neurosurgery. The logistic regression function (LR model) of these four independent risk factors had a better performance on diagnostic value of DVT in patients after neurosurgery. Conclusion. The combined factor was constructed by hypertension, postoperative D-dimer, gender, and GCS score, and it might be a more handy and reliable marker to stratify patients at risk of DVT after neurosurgery.

A prospective study to evaluate the use of surveillance venous ultrasonography to detect incidence of deep venous thrombosis following neurosurgical excision of brain tumors

“…found that hypertension (Odd’s ratio [OR] – 3.2, 95% CI: 1.46–6.82; P = 0.003) and high post-operative D-dimer (OR - 1.2, 95% CI: 1.02–1.48; P = 0.034) were the independent risk factors for the occurrence of DVT following neurosurgery. [ 16 ] In our study, the sample population was relatively younger (mean age – 44 years), without major comorbidities (ASA 1–58%), and with no major motor weakness (power in each of the limbs ≥4 was noted in 90% of patients). These could be the reasons for the low incidence of DVT noted in our study.…”

Thromboembolic prophylaxis in neurosurgical practice: a systematic review

“…Eleven studies reported patients both subjected to intracranial and spinal surgery (intracranial/spinal). Eight studies diagnosed DVT on clinical grounds [ 7 , 10 , 13 , 14 , 38 , 41 – 43 ], and sixteen studies diagnosed DVT based on systematic screening methods, using D-dimer [ 16 , 18 , 19 , 21 , 30 , 36 ], DUS [ 1 – 3 , 6 , 8 , 16 , 18 – 21 , 25 , 30 , 34 – 36 , 47 ], or CT [ 47 ]. One study evaluated both on clinical grounds and performed routine screening (DUS/CT), with the purpose of comparing the two methods [ 40 ].…”

“…Our analysis yielded 14 studies with a low risk of bias (Tables 1 and 2 , printed in bold; Table 5 ) [ 1 , 2 , 6 , 10 , 16 , 19 – 21 , 25 , 30 , 34 , 35 , 40 , 41 ]. In these studies, the reported incidence of VTE was 4.0% (clinical evaluation) in patients not receiving antithrombotic prophylaxis [ 10 ].…”

A nomogram for individualized prediction of lower extremity deep venous thrombosis in stroke patients: A retrospective study

“…In addition, multiple literature articles identified D-dimer as a reliable marker for detecting DVT. [25][26][27][28] Wells PS et al [29] believed that DVT may be ruled out in patients who were less likely to have deep venous thrombosis, with a negative result in the D-dimer test. Ultrasonography may be omitted in such patients.…”