Incidence of venous thromboembolism in pelvic and acetabular fractures in the Japanese population

Niikura, Takahiro; Lee, Sang Yang; Oe, Keisuke; Koh, Akihiro; Koga, Takaaki; Dogaki, Yoshihiro; Okumachi, Etsuko; Kurosaka, Masahiro

doi:10.1007/s00776-012-0203-2

Cited by 20 publications

(15 citation statements)

References 25 publications

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“…Extensive and deep understanding of the related risk factors is critical for prevention of occurrence of DVT, and it is of more clinical significance to distinguish between proximal and distal venous thrombosis, which allows more accurate diagnosis and management of DVT. While DVT has been extensively studied in major trauma, such as hip fracture, spinal fracture, pelvic and acetabular fracture, and multiple trauma [4][5][6][7], there is still lack of epidemiologic data on DVT following tibial plateau fracture. In most cases, the limited sample size in a single institution provided underpowered statistical analyses.…”

Section: Introductionmentioning

confidence: 99%

Incidence and locations of preoperative deep venous thrombosis (DVT) of lower extremity following tibial plateau fractures: a prospective cohort study

Zhu

Chen

et al. 2021

J Orthop Surg Res

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Background There is still lack of data on deep vein thrombosis (DVT) following bone trauma. This study aimed to determine the epidemiologic characteristics of deep venous thrombosis (DVT) of lower extremities following tibial plateau fractures. Methods Retrospective analysis of prospectively collected data on patients presenting with tibial plateau fractures between October 2014 and December 2018 was conducted. Duplex ultrasonography (DUS) was routinely used to screen for preoperative DVT of bilateral lower extremities. Data on demographics, comorbidities, injury-related data, 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 A total of 1179 patients were included, among whom 192 (16.3%) had a preoperative DVT, with incidence rate of 1.0% for proximal and 15.3% for distal DVT. The average interval between fracture occurrence and diagnosis of DVT was 3.5 days (median, 2 days), ranging from 0 to 19 days. DVT involved the injured extremity in 166 (86.4%) patients, both the injured and uninjured extremities in 14 patients (7.3%) and only the uninjured extremity in 12 patients (6.3%). Six risk factors were identified to be associated with DVT, including gender (male vs female), hypertension, open fracture, alkaline phosphatase > 100 u/L, sodium concentration < 135 mmol/L, and D-dimer > 0.5 mg/L. Conclusion These epidemiologic data are conducive to the individualized assessment, risk stratification, and development of targeted prevention programs.

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Section: Introductionmentioning

confidence: 99%

Incidence and locations of preoperative deep venous thrombosis (DVT) of lower extremity following tibial plateau fractures: a prospective cohort study

Zhu

Chen

et al. 2021

J Orthop Surg Res

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“…21,22 Several authors recognized the impact of surgical interventions to increase the risk for VTE after fractures. [4][5][6][7][8][9][10] A less invasive and highly accurate screening tool for VTE is needed that would allow immediate treatment. In this study, both TAT and D-dimer levels were higher in patients with postoperative VTE than in those without postoperative VTE, with statistical significance on postoperative days 1, 3, and 7.…”

Section: Discussionmentioning

confidence: 99%

Thrombin–antithrombin III complex tests

Lee

Niikura

Igarashi

et al. 2017

J Orthop Surg (Hong Kong)

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Purpose: Patients with fractures of the pelvis and/or lower extremities are at a high risk of developing postoperative venous thromboembolism (VTE). The purpose of this study was to determine whether the thrombin-antithrombin III complex (TAT) tests could be used for postoperative screening of VTE in patients with lower limb or pelvic fractures. Methods: We enrolled 133 patients who underwent surgical treatment for fracture of the pelvis or lower extremities. TAT and D-dimer levels were compared in patients with and without VTE. Receiver operating characteristic (ROC) curve analysis was done and the appropriate TAT and D-dimer cutoff levels were determined for VTE screening. Results: VTE was diagnosed in 41 patients (30.8%). Patients with VTE had significantly higher levels of TAT and D-dimer on postoperative days 1, 3, and 7 than those without VTE, respectively. ROC curve analysis suggested that TAT test at postoperative day 7 had the highest accuracy for predicting postoperative VTE. With the optimal cutoff TAT level of 3.0 ng/mL, sensitivity and specificity were 93.3% and 70.1%, respectively. With the optimal cutoff D-dimer level of 7.4 mg/mL, sensitivity and specificity were 93.3% and 57.0%, respectively. Conclusion: TAT levels measured at postoperative day 7 could be the most useful parameter for screening postoperative VTE. TAT can be used as a screening tool for screening postoperative VTE in patients with lower limb and pelvic fractures.

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“…10 The external fixator may cause artefacts on imaging. Ultrasonography is non-invasive and easy to use, although it is technically difficult to perform ultrasonography on a body part with an external fixator.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were screened for VTE using contrast-enhanced computed tomography (CT) when the D-dimer value did not decrease as expected or exceeded 20 (normal, <1) µg/ml after 5 postoperative days. 10 Between May 2009 and December 2012, 18 men and 4 women (mean±SD age, 45±18 years) underwent temporary external fixation followed by intramedullary nailing (n=14) or plating (n=11) for a total of 8 femoral and 20 tibial fractures. Seven patients had associated injuries of the head, chest, abdomen, spine, and pelvis.…”

Section: Methodsmentioning

confidence: 99%

Rate of Venous Thromboembolism after Complex Lower-Limb Fracture Surgery without Pharmacological Prophylaxis

Niikura

Sakai

Lee

et al. 2015

J Orthop Surg (Hong Kong)

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Purpose. To evaluate the rate of venous thromboembolism (VTE) after complex lowerlimb fracture surgery without pharmacological prophylaxis. Methods. Between July 2005 and April 2009, 11 men and 6 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 3 femoral and 20 tibial fractures. Patients were screened for VTE using contrastenhanced computed tomography (CT) when the D-dimer value was beyond normal range. Between May 2009 and December 2012, 18 men and 4 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 8 femoral and 20 tibial fractures. Patients were routinely screened for deep vein thrombosis (DVT) using ultrasonography and for pulmonary embolism (PE) using contrast-enhanced CT (in high-risk patients with multiple injuries or pelvic and acetabular fractures). In both groups, pharmacological prophylaxis was not Rate of venous thromboembolism after complex lower-limb fracture surgery without pharmacological prophylaxis used; only mechanical prophylaxis was used.Results. The 2 groups were comparable in terms of age, sex, and proportion of bilateral external fixation, open fracture, and associated injury, except that the duration of external fixation was longer in the early group (29.8±28.0 vs. 11.6±4.0 days, p=0.001). Of the 17 patients in the early group, 5 developed VTEs (3 DVTs and 2 PEs) at a mean of 13.6 (range, 6-20) days after injury; 2 of whom developed VTE during the external fixation period. Of the 22 patients in the later period, 10 developed VTEs (10 DVTs and 4 PEs) at a mean of 13 (range, 5-33) days after injury; 7 of whom developed VTE during the external fixation period. Conclusion. The rate of VTE was high in patients undergoing complex lower-limb fracture surgery without pharmacological prophylaxis.

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Incidence of venous thromboembolism in pelvic and acetabular fractures in the Japanese population

Cited by 20 publications

References 25 publications

Incidence and locations of preoperative deep venous thrombosis (DVT) of lower extremity following tibial plateau fractures: a prospective cohort study

Incidence and locations of preoperative deep venous thrombosis (DVT) of lower extremity following tibial plateau fractures: a prospective cohort study

Thrombin–antithrombin III complex tests

Rate of Venous Thromboembolism after Complex Lower-Limb Fracture Surgery without Pharmacological Prophylaxis

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