Duplex ultrasound for evaluation of deep venous blood flow in fractured lower extremities

Adam, Awadalla; Yousef, Mohamed; Wahab, Babiker A.; Abukonna, Ahmed; Mahmoud, Mustafa Z.

doi:10.5114/pjr.2018.73291

Cited by 6 publications

(7 citation statements)

References 22 publications

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“…The occurrence of DVT was significantly correlated with the fracture site. Similar to the results of Adam et al and Zhang et al [ 16 , 17 ], the incidence of hip fracture (74.90%) was relatively high. Considering that most patients with hip fractures may have three risk factors of Virchow at the same time [ 18 ], we should pay attention to the screening of DVT in these patients with fractures at specific sites and formulate reasonable individualized prevention and treatment strategies.…”

Section: Discussionsupporting

confidence: 88%

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

Cheng

2020

J Orthop Surg Res

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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.

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Section: Discussionsupporting

confidence: 88%

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

Cheng

2020

J Orthop Surg Res

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“…In general, patients who undergo a hip fracture exhibit all three risk factors associated with Virchow’s triad, which contribute to the high occurrence of DVT 40. Besides, we observed statistical differences in the incidence of DVT of different fracture sites ( P <0.01), indicating a similar result as Awadalla Adam’ research, which found that the incidence of DVT after orthopaedic trauma appears to be associated with the sites of fractures 41. Of the multiple fracture sites, we found hip fracture presented with the highest rate of DVT, demonstrating that hip fracture may be a risk factor for DVT.…”

Section: Discussionsupporting

confidence: 83%

A Retrospective cohort study on the risk factors of deep vein thrombosis (DVT) for patients with traumatic fracture at Honghui Hospital

Zhang

Huai

Wang³

et al. 2019

BMJ Open

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ObjectiveTo explore the risk factors of perioperative deep vein thrombosis (DVT) in patients with traumatic fracture after orthopaedic surgery and their potential diagnostic values in clinical.DesignRetrospective cohort study.SettingClinical Laboratory of Honghui Hospital, Xi’an JiaoTong University College of Medicine, Xi’an, Shaanxi, China.Materials and methodsA retrospective cohort study was conducted with surgically treated fracture patients in Honghui Hospital from 1 May 2016 to 31 February 2017.χ2test, independent sample t test and regression analysis were applied to examine the correlation between perioperative DVT and the factors of preoperative time, fracture sites, D-dimer value and chronic diseases (hypertension, diabetes and coronary disease).Results462 patients were enrolled for analysis. The preoperative time of patients with DVT was significantly longer than that of non-DVT patients (7.14±5.51 vs 5.45±3.75) (P<0.01).χ2test showed the significant differences in the rate of DVT among patients with different fracture sites (P<0.01). By the receiver-operating characteristic curve analysis, the cut-off value of preoperative D-dimer and postoperative D-dimer in diagnosing perioperative DVT was 4.01 µg/mL and 5.03 µg/mL, respectively. Area under the curve was 0.593 (95% CI 0.533 to 0.652) and 0.728 (95% CI 0.672 to 0.780), respectively. The sensitivity and specificity of preoperative D-dimer for DVT diagnosis were 71.30% and 44.83%, and as for postoperative D-dimer were 63.90% and 70.51%.ConclusionsFracture site was correlated to the incidence of DVT; prolonged preoperative time and increased D-dimer value were independent risk factors for DVT in patients with lower extremity traumatic fractures.

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“…Among fracture patients, the current routine anticoagulant regimens are used for the prevention and treatment of DVT in patients with different risks, which does not change the current situation that the incidence of DVT is still relatively high.It is particularly important to further clarify independent risk factors for DVT to identify high risk groups.The occurrence of DVT was signi cantly correlated with the fracture site. Similar to the results of Adam and Zhang [12,13] , the incidence of hip fracture (74.90%) was relatively high. Considering that the three risk factors of Virchow were mostly present in the patients with hip fracture [14] .We should pay attention to the screening of DVT in these patients with fractures at speci c sites, and formulate reasonable individualized prevention and treatment strategies.Meizoso et al used RAP score in a retrospective cohort study of 1233 trauma patients and found that transfusion of more than 4 units was an independent risk factor for DVT [15] .The preoperative, intraoperative and postoperative blood transfusion rates of 569 patients in this study were 8.44% (48/569), 29.70% (169/569), and 13.88% (79/569), respectively.It was further found that intraoperative blood transfusion and postoperative blood transfusion were independent risk factors for postoperative DVT, while preoperative blood transfusion was not correlated with DVT.Perhaps we should reconsider the indications and necessity of blood transfusion in practice.Song et al reported that most patients with postoperative DVT had complicated DVT before surgery [16] ,In this study, preoperative DVT occurred in 26.71% of the patients, which was considered to be related to the longer average preoperative waiting time.Most of the current recommendations are that surgery should be performed as soon as possible within 48 hours after trauma to reduce the incidence of VTE [17] .But in practice, 66 percent of patients with hip fractures delayed surgery [18] .The reasons for delayed surgery may be as follows.…”

Section: Discussionsupporting

confidence: 85%

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

Cheng

2020

Preprint

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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.

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Duplex ultrasound for evaluation of deep venous blood flow in fractured lower extremities

Cited by 6 publications

References 22 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

A Retrospective cohort study on the risk factors of deep vein thrombosis (DVT) for patients with traumatic fracture at Honghui Hospital

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

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