Characterization of perioperative deep venous thrombosis and plasma D-dimer in elderly patients with hip fracture

Abstract

Objective To characterize deep venous thrombosis(DVT)and plasma D-dimer during perioperative period in elderly patients with hip fracture. Methods The clinical data of 224 elderly patients with hip fracture were analyzed retrospectively who had been admitted to our department from January 2014 through February 2015. They were 82 men and 142 women, 65 to 93 years of age(average, 77. 4 years). They included 96 femoral neck fractures and 128 intertrochanteric fractures. Joint replacement was conducted in 101 cases and internal fixation in 123 ones. The concentration of plasma D-dimer was measured on the day of admission, one day before surgery, one, 3 and 5 days after surgery, respectively. Moreover, B-ultrasonic examination on both lower limb veins was performed preoperatively and postoperatively. Results The B-ultrasound examination revealed DVT in 64 cases(28. 6%)before operation, mainly on 3 to 6 days after injury. There were 53 cases of distal thrombosis(82. 8%)and 11 ones of mixed thrombosis(17. 2%). Postoperative DVT happened in 118 cases(52. 7%), mainly within 3 days postoperatively. There were 105 cases of distal thrombosis(89. 0%), one case of proximal thrombosis(0. 8%), and 12 cases of mixed thrombosis(10. 2%). The concentration of plasma D-dimer was respectively 11. 88 ±13. 42 mg/L, 9. 29 ±10. 99 mg/L, 10. 25 ±9. 04 mg/L, 7. 93 ±7. 04 mg/L and 7. 00 ±6. 53 mg/L on the day of admission, one day before surgery, one, 3 and 5 days after surgery, showing a significant difference(F= 8. 048, P= 0. 012). The concentration of plasma D-dimer on the day of admission was significantly higher than that on one day before surgery, 3 and 5 days after surgery(P< 0. 05). Conclusions The incidence of perioperative DVT is high in elderly patients with hip fracture. The distal thrombosis predominates. Most of the perioperative DVT events happen on 3 to 6 days after injury and within 3 days after surgery. D-dimer measurement has a limited value in DVT screening for elderly patients with hip fracture. Key words: Hip fractures; Venous thrombosis; D-dimer; Ultrasonography, Doppler, color; Aged