The detection and management of proximal deep venous thrombosis in patients with acute acetabular fractures: a follow-up report.

Abstract

To determine the efficacy of a thromboprophylaxis protocol that included deep venous thrombosis (DVT) prophylaxis (subcutaneous heparin), preoperative screening with magnetic resonance venography (MRV), and therapeutic management (vena caval interruption preoperatively, therapeutic heparin anticoagulation postoperatively) when indicated. Prospective, consecutive. Tertiary referral, teaching hospital in New York City. One hundred one patients with acutely displaced acetabular fractures. Preoperative MRV was performed to assess vascular structures. Patients with proximal DVT received vena caval filter interruption preoperatively and therapeutic warfarin postoperatively. Patients without proximal DVT received only subcutaneous heparin preoperatively and low-dose warfarin postoperatively. Forty-nine asymptomatic thrombi were identified in thirty-four of 101 patients (34 percent). Location of thrombi were in the popliteal vein in four of forty-nine patients (8 percent), superficial femoral vein in eight of forty-nine (16 percent), common femoral vein in thirteen of forty-nine (27 percent), external iliac vein in six of forty-nine (12 percent), internal iliac vein in fourteen of forty-nine (29 percent), and common iliac vein in four of forty-nine (8 percent). Thrombi were isolated to the injured extremity in twenty-six of thirty-four patients (76 percent), bilateral in four of thirty-four (12 percent), and isolated to the uninjured extremity in four of thirty-four (12 percent). Twenty-six of the thirty-four patients with proximal thrombi received preoperative vena caval filters. As a result of this protocol, only one patient (1 percent) developed a nonfatal pulmonary embolism. MRV is a sensitive screening examination that allows the placement of inferior vena caval filters based on documented proximal thrombosis. We anticipate that preoperative DVT screening with MRV will significantly decrease the incidence of fatal pulmonary embolism in this high-risk population.