The Perioperative Deep Vein Thrombosis in Lower Extremities in Patients With Pelvic Fracture: A Case-Control Study

BackgroundDeep vein thrombosis (DVT) is a common complication in orthopedic patients. Previous studies have focused on major orthopedic surgery.There are few studies with multiple trauma. We aimed to describe the prevalence of DVT and compare the predictive power of the different risk assessment scales in patients with multiple trauma.MethodsThis prospective cohort study involved multiple trauma patients admitted to our hospital between October 2021 and December 2022. Data were prospectively collected for thrombotic risk assessments using the Risk Assessment Profile for thromboembolism(RAPT), the DVT risk assessment score (DRAS), and the Trauma Embolic Scoring System (TESS), respectively. The receiver operation characteristic (ROC) curve and the area under the curve (AUC) were evaluated to compare the predictive power. The whole leg duplex ultrasound of both lower extremities Doppler ultrasound was used to determine DVT incidence.ResultsA total of 210 patients were included, and the incidence of DVT was 26.19%. Distal DVT accounted for 87.27%; postoperative DVT, 72.73%; and bilateral lower extremity thrombosis, 30.91%. There were significant differences in age, education degree, pelvic fracture, surgery, ISS, D-dimer level, length of hospital stay and ICU stay between the thrombosis group and the non-thrombosis group. The AUCs for RAPT, DRAS, and TESS were 0.737, 0.710, and 0.683, respectively. There were no significant differences between the three ROC curves.ConclusionsThe incidence of DVT was relatively high during hospitalization. We prospectively validated the tests to predict risk of DVT among patients with multiple trauma to help trauma surgeons in the clinical administration of DVT prophylaxis.

BackgroundDeep vein thrombosis (DVT) significantly influences the prognosis of patients. It’s necessary to analyze the risk factors for postoperative DVT in patients undergone gynecological laparoscopic surgery.MethodsPatients who underwent gynecological laparoscopic surgery from January 1, 2018 to May 31, 2020 were included. The characteristics and clinical data of DVT and non DVT patients were collected and analyzed. Logistic regression analysis was performed to identify the risk factors of DVT in patients undergone gynecological laparoscopic surgery.ResultsA total of 355 patients undergone gynecological laparoscopic surgery were included, the incidence of postoperative DVT was 11.55%. There were significant differences in the age, hypertension, D-dimer, duration of surgery, intraoperative pneumoperitoneum pressure, duration of days in bed between DVT and non-DVT groups (all p < 0.05), and there were no significant difference in the BMI, diabetes, hyperlipidemia, ASA classification and intraoperative blood transfusion between DVT and non-DVT groups (all p > 0.05). Age > 50 years (OR 4.246, 95% CI 1.234–7.114), hypertension (OR 2.219, 95% CI 1.153–4.591), D-dimer > 0.5 mg/L (OR 3.914, 95% CI 1.083–5.229), duration of surgery ≥ 60 min (OR 2.542, 95% CI 1.101–4.723), intraoperative pneumoperitoneum pressure ≥ 15 mmHg (OR 3.845, 95% CI 1.119–5.218), duration of days in bed > 3 days (OR 1.566, 95% CI 1.182–1.994) was the independent risk factors for DVT in patients undergone gynecological laparoscopic surgery (all p < 0.05).ConclusionsThe incidence of postoperative DVT in patients undergone gynecological laparoscopic surgery is high, and those high-risk factors should be targeted to intervene in order to reduce the postoperative DVT.

Objective To investigate the incidence and risk factors of deep venous thrombosis (DVT) of lower extremity in patients with pelvic or acetabular fracture. Methods From August 2015 to December 2016, 110 patients with pelvic or acetabular fracture were treated in our hospital. They were 76 males and 34 females with a mean age of 44.2 years (range, from 16 to 76 years). There were 48 pelvic fractures, including 12 anterior and posterior compression, 16 lateral compression and 20 vertical shear ones by the Young-Burgess classification; there were 62 acetabular fractures, including 26 simple and 36 complex ones by the Letournel-Judet classification. The incidence of lower extremity DVT was detected preoperatively and postoperatively using ultrasound detection. The factors associated with the incidence of DVT were analyzed statistically. The risk factors were screened by single factor logistic regression analysis; the major independent risk factors were determined by multi-factor logistic regression analysis. P< 0.05 was considered as statisti-cally significant. Results DVT occurred in 32 patients (29.09%), including 21 cases (19.09%) of proximal thrombosis and 3 cases of combined pulmonary embolism. The incidence of DVT in patients with acetabular fracture was significantly higher than in those with pelvic fracture (P 60 years, combined injuries and interval of >2 weeks from injury to surgery were independent risk factors for incidence of DVT (P< 0.05). Conclusions The risk of lower extremity DVT is high in patients with pelvic or acetabular fracture in spite of active prophylaxis, especially the risk of proximal thrombosis. Age of >60 years, combined injuries and interval of >2 weeks from injury to surgery may be the independent risk factors for incidence of DVT. Key words: Pelvis; Acetabulum; Fractures, bone; Venous thrombosis; Risk factors

The background of our research was to conduct a retrospective analysis of clinical signs and risk factors for acute deep vein thrombosis (ADVT) of lower extremities, and to compare the effectiveness and safety of therapy of LMWH bemiparin and UFH in patients after abdominal surgery for cancer.

BackgroundThe relationship between thromboelastogram (TEG) hypercoagulation status and perioperative deep vein thrombosis (DVT) in patients with femoral and pelvic fractures is not well understood. We aimed to investigate the relationship between hypercoagulation status identified by thromboelastography and postoperative DVT formation in patients with femoral and pelvic fractures, as well as to evaluate the role of thromboelastography in assessing hypercoagulation status and predicting postoperative DVT formation.MethodsData from 2,065 patients with femoral and pelvic fractures who underwent surgical treatment at a hospital in China between May 2018 and December 2023 were retrospectively analysed. Hypercoagulable TEG was defined as reaction time (R) < 5 min, coagulation time (K) < 1 min, alpha angle (α) > 72 degrees, maximum amplitude (MA) > 70 mm, and/or coagulation index (CI) > 3. The correlation between preoperative hypercoagulability identified by TEG and postoperative DVT formation was assessed using multivariate logistic regression. Propensity score matching (PSM) was performed to control for confounding factors.ResultsCompared to the non-DVT group, the DVT group had decreased R and K values, while the α, MA, and CI values significantly increased (P < 0.05). Multivariate logistic regression analysis demonstrated that hypercoagulable TEG findings were predictive of postoperative DVT formation. PSM, using a 0.1 calliper value, matched 296 patients from the hypercoagulation and non-hypercoagulation groups in a 1:1 ratio. Before PSM, hypercoagulable TEG was associated with DVT in femoral and pelvic fractures (P < 0.001, odds ratio [OR]:1.860, 95% confidence interval: 1.389–2.492). After PSM, these two variables remained correlated (P = 0.001, OR = 1.878, 95% confidence interval:1.301 − 2.709).ConclusionsThe hypercoagulable state identified by TEG can predict thromboembolic events in patients with femoral and pelvic fractures.Trial registrationThe study was registered in the Chinese Clinical Trial Register (https://www.chictr.org.cn/bin/home) on April 16, 2024, with registration number ChiCTR2400083135.

A background of Pulmonary Hypertension (PH) indicates a progressive elevation of pulmonary vascular resistance, leading to overfilling, elevation of venous pressure, congestion in various organs, and edema in the venous system. This study aimed to investigate whether PH is a risk factor for deep vein thrombosis (DVT) of the lower extremities after hip and knee replacement surgery. A total of 238 patients who received joint replacement of lower extremities in our department of orthopedics from January 2009 to January 2012 were examined by echocardiography and Color Doppler flow imaging (CDFI) of the lower extremities. Based on pulmonary artery pressure (PAP), the patients were divided into a normal PAP group (n=214) and PH group (n=24). All the patients were re-examined by CDFI during post-operative care. Among the 238 patients, 18 had DVT in the lower extremities after the operation. DVT total incidence rate was 7.56% (18/238). In the PH group, 11 patients had DVT (45.83%, 11/24), but in the normal PAP group, only 7 had DVT (3.27%, 7/214). The incidence of DVT was significantly lower in the normal PAP group than in the PH group (P<0.01). In addition, there was a positive correlation between PAP and the incidence of DVT. PH could be a high-risk factor for the occurrence of DVT in patient's lower extremities after joint replacement surgeries.

To make preliminary cross-sectional study on epidemiology of deep vein thrombosis of lower extremity of inpatients with high risk in Zhongshan hospital, and analyze risk factors in these patients. From Sep 2008 and Feb 2009, we performed compressed ultrasound to detect deep vein thrombosis of lower extremity of in-patients with high-risk in Zhongshan hospital, including bedrid stroke patients, post-surgery bedrid patients from department of orthopaedics, gynecology, general surgery and vascular surgery and patients of surgical intensive care unit. Prevalence rate of DVT of the whole study group as well as each department were calculated and analyzed. We collected detailed clinical information of each recruited patient. We made statistical single-factor and then Logistic regression multiple-factor analysis of these data with SPSS 16.0, to determine high risks of deep vein thrombosis of in-patients. (1) Totally 372 patients were enrolled in our study with 38 patients detected with DVT of lower extremity, so the prevalence rate of whole series was 10.2% (38/372). (2) High risks of lower extremity deep vein thrombosis for the whole series were bedrid time (30 day boundary) (P = 0.000), thrombin time (P = 0.007) and history of vascular surgery (P = 0.009). (3) The prevalence rate of DVT of lower extremity of department of neurology, orthopaedics and gynecology were 12.7% (13/102), of 10.0% (10/100) and 6.3% (7/111) respectively. (4) High risk for DVT in post-surgery gynecological patients was resection of uterus and both attachments (P = 0.032). In our study, the prevalence rate of DVT of lower extremity for high-risk in-patients was high, most of whom were asymptomatic and left-sided. High risk factors were bedrid time (30 day boundary), thrombin time and history of vascular surgery. It is necessary to strengthen prophylactic anticoagulation in these patients.

Introduction: Deep vein thrombosis (DVT) is the presence of thrombus in deep venous system, commonly encountered in lower extremities. P. S. Wells was one of the pioneers to diagnose DVT without relying on imaging methods and using the clinical criteria for patient management. Methods: All the patients with clinical suspicion of DVT in lower extremities (new onset edema, pain) visiting the Outpatient Department or Emergency Department of Dhulikhel Hospital between September 2012 and August 2016 were included in the study. The patients were asked/examined for knowing all the points in Wells' criteria. Confirmation of the diagnosis was done by color Doppler ultrasonography on the same day by a radiologist. The patients were categorized into three groups as ≥3 as high probability, 1–2 as moderate probability, and <0 as low probability. Results: There were 68 patients with a history suggestive of DVT. Doppler ultrasonography being considered as gold standard for diagnosis confirmed 65 cases as DVT (95.6%) on the 1st day and remaining 3 cases were confirmed on the 3rd day in repeat Doppler ultrasonography. Mean age was 55.5 years (range: 34–75, standard deviation [SD] 11.3 years). Mean days of history was 3 days (range 1–10 days, SD 2.2 days). Pitting edema was present in 95.6% of cases which was the most common clinical characteristic in patients with DVT. This was followed by swelling of entire leg (67.6%), followed by localized tenderness along the distribution of deep venous system (64.7%). In 51 cases (75%), Wells' score was ≥3 (high probability), while in 14 cases (20.6), it was 1–2 (moderate probability) and in 3 cases (4.4%) it was <0 (low probability). In terms of positive Wells' score (≥2), there were 55 cases (80.9%). Conclusion: Wells' scoring can be used for diagnosis of DVT in lower extremities, but for further accuracy, it needs to be reconfirmed by Doppler ultrasonography.

ObjectiveThis study aims to explore the clinical correlation between nonspecific ST-segment or T-wave (NS-STT) changes and perioperative deep vein thrombosis (DVT) in patients with lower extremity fractures.MethodsOne thousand four hundred sixty-nine consecutive patients who suffered lower extremity fractures were screened at Xi’an Honghui Hospital between Feb 2016 and Nov 2018. According to the included and excluded criteria, the patients were included in this retrospective study. After collecting the electrocardiogram baseline, the patients were divided into the NS-STT group and the non-NS-STT group. After comparing the demographic and clinical characteristics, multivariate logistic regression models were used to identify the role of NS-STT changes on perioperative DVT. All analyses were performed with R and EmpowerStats software.ResultsNine hundred and sixty-eight patients were included in the study. Ninety-seven patients (10.02%) had NS-STT changes on the electrocardiogram at admission. A total of 303 patients (31.30%) developed perioperative DVT in lower extremities. The univariate analysis showed that NS-STT segment changes were correlated with perioperative DVT significantly (OR = 3.45, 95% CI: 2.25–5.30, P < 0.0001). In addition, age ≥50 (P < 0.0001), female (OR = 1.50, 95% CI: 1.14–1.97, P = 0.0038), hypertension (OR = 1.54, 95% CI: 1.08–2.20, P = 0.0161), blood transfusion (OR = 1.78, 95% CI: 1.34–2.37, P < 0.0001), joint prosthesis (OR = 3.26, 95% CI: 2.21–4.81, P < 0.0001), and blood loss ≥300 mL (OR = 2.12, 95% CI: 1.50–3.01, P < 0.0001) were associated with perioperative DVT in lower extremities. We identified the confounding factors of age, gender, classification of internal implants, operation time, blood loss, and infusion. After adjustment for potential confounding factors, NS-STT changes were associated with perioperative DVT (OR = 2.13, 95% CI: 1.33–3.42; P = 0.0017). The sensitive analysis showed that the result was stable.ConclusionThe NS-STT changes on electrocardiograms are associated with an increase in the incidence of perioperative DVT by 2.13-fold in patients with lower extremity fractures under 75 years old. In clinical practice, surgeons should pay more attention to these patients.

To assess the performance of magnetic resonance venography (MRV) for pelvis and deep vein thrombosis in the lower extremities before surgical interventions for varicose veins. We enrolled 72 patients who underwent MRV and ultrasonography before stripping for varicose veins of lower extremities. All images of the deep venous systems were evaluated by time-of-flight MRV. Forty-six patients (63.9%) of all were female. Mean age was 65.2 ± 10.2 years (37-81 years). There were forty patients (55.6%) with varicose veins in both legs. Two deep vein thrombosis (2.8%) and three iliac vein thrombosis (4.2%) were diagnosed. All patients without deep vein thrombosis underwent the stripping of saphenous veins, and post-thrombotic change was avoided in all cases. MRV, without contrast medium, is considered clinically useful for the lower extremity venous system.

A prospective study comparing duplex scan and venography for diagnosis of lower-extremity deep vein thrombosis

This study was designed to compare duplex scanning with contrast venography for the diagnosis of acute deep vein thrombosis of the lower extremity, both at the femoropopliteal (above-knee) and tibioperoneal (below-knee) levels. A total of 216 patients with 220 limbs suspected of acute deep vein thrombosis underwent duplex scanning followed within 24 h by ascending venography. The two studies were interpreted independently by two physicians who were blinded to the results of the corresponding alternative study. Venography was positive for deep vein thrombosis in 44.5% of cases (98/220). Duplex scanning was inadequate at the above-knee level in two cases (0.9%) and at the below-knee level in 17 cases (7.7%). Sensitivity and specificity of duplex scanning at above-knee level were 98.7% and 100% respectively while corresponding values were 85.2% and 99.2% at below-knee level. By excluding technically inadequate duplex studies, the sensitivity at below-knee level was clearly improved (93.8%). It is concluded that with meticulous technique, duplex scanning is highly accurate in diagnosing acute deep vein thrombosis of symptomatic lower extremities, avoiding contrast venography in over 90% of the cases, even at the tibioperoneal level.

Objectives: Venous thromboembolis is a clinical condition that often occurs from deep vein thrombosis of lower extremity. The incidence of deep venous thrombosis in the etiology of pulmonary thromboembolism may be as high as 90%. Doppler ultrasonography of lower extremities is recommended generally to determi- nate the etiology of pulmonary thromboembolism. The aim of this study is to present the importance of upper extremity thrombosis in pulmonary thromboembolism. Materials and Methods: Between 2010- 2012, 236 patientsfollowed with the diagnosis of pulmonary throm- boembolism were included in the study. Lower and upper extremity doppler examination was performed to all patients to determinate the cause. Results: The mean age of patients is 64,7± 16,9 (22- 95); 56,8% (134) were female, 43,2% (102) were men. According to the classification of pulmonary thromboembolism , 37 (15,7%) patients had massive, 103 (43,6%) patients had submassive, 96 (40,7%) patients had nonmassive embolism. Lower extremity deep ve- nous thrombosis was detected in 109 (46,2%) patients, both lower and upper extremity in 10 (4,2%) patients and only upper extremity in 20 (8,4%) patients. Eventually, deep venous thrombosis was detected in 129 (54,6%) patients. Thrombosis of the upper extremity was detected in 20 (16,8%) patients. Conclusions: Upper extremity thrombosis has been found as important as lower extremity thrombosis in the etiology of venous thromboembolism. Upper extremity thrombosis does not always occur in patients with malignancy or central venous catheters It should be kept in mind that, in hospitalized patients with peripheral vascular vein catheter, the upper extremity thrombosis may also occur.

Study of deep venous thrombosis in lower extremities after femoral neck fracture

Deep vein thrombosis (DVT) is a significant postoperative concern, particularly in patients undergoing surgery for gastrointestinal (GI) cancers. These patients often present multiple risk factors, including advanced age and elevated body mass index (BMI), which can increase the likelihood of thromboembolic events. Effective prophylaxis is crucial in this high-risk population to minimize complications such as DVT and pulmonary embolism (PE). This study investigates a comprehensive DVT prevention protocol, combining mechanical and pharmacological strategies alongside early mobilization, to evaluate its effectiveness and safety in reducing postoperative thrombosis rates among GI cancer surgery patients. To evaluate the effectiveness and safety of postoperative DVT prevention strategies in patients with GI cancer. A prospective cohort study was conducted involving 100 patients who underwent surgery for GI tumors between January and December 2022. All patients received a standardized DVT prevention protocol, which included risk assessment, mechanical prophylaxis, pharmacological prophylaxis, and early mobilization. The primary endpoint was the incidence of DVT within 30 days postoperatively. Secondary outcomes included the occurrence of PE, bleeding complications, and adherence to the protocol. The overall incidence of DVT was 7% (7/100 patients). One patient (1%) developed PE. The adherence rate to the prevention protocol was 92%. Bleeding complications were observed in 3% of patients. Significant risk factors for DVT development included advanced age [odds ratio (OR): 1.05; 95% confidence interval (95%CI): 1.01-1.09], higher BMI (OR: 1.11; 95%CI: 1.03-1.19), and longer operative time (OR: 1.007; 95%CI: 1.001-1.013). Implementing a comprehensive DVT prevention and management protocol for patients undergoing GI tumor surgery resulted in a lower incidence. Strict adherence and individualized risk assessment are crucial for optimizing outcomes.