Incidence Of Postoperative Deep Venous Thrombosis Research Articles

Effect of Low Molecular Weight Heparin Calcium on Prevention of Lower Limb Deep Venous Thrombosis in Oral Cancer Patients With Anterolateral Thigh Flap Reconstruction.

This study aimed to evaluate the effect of low molecular weight heparin calcium (LMWH-Ca) on the prevention of deep venous thrombosis (DVT) in patients with anterolateral thigh (ALT) flap reconstruction. In total, 1001 patients with oral cancer who underwent ALT flap reconstruction were recruited. Based on the postoperative use of LMWH-Ca, the patients were divided into case (n = 633) and control groups (n = 368). The incidence of postoperative DVT was compared between groups. There was no significant difference in DVT incidence between the two groups. Among patients older than 60 years, the incidence of lower limb DVT in the case group (0.813%) was significantly lower than that in the control group (8.108%, p = 0.012). The postoperative use of LMWH in oral cancer patients with ALT flap transfer does not prevent the development of lower limb DVT. However, patients older than 60 years old benefited from the postoperative use of LMWH-Ca.

Analysis of Risk Factors of Postoperative Lower Extremity Deep Venous Thrombosis in Patients With Cervical Cancer.

Deep venous thrombosis (DVT) has a significant negative impact on surgical and tumor patient's safety and quality of life. There was no specific report on the incidence and risk factors of postoperative lower extremity DVT in cervical cancer patients. Analysis of the risk factors of postoperative DVT in patients with cervical cancer is of great clinical significance for prevention and treatment. We retrospectively analyzed 309 cervical cancer patients treated by the Hubei Cervical Cancer Prevention Center and used a logistic regression model to test the risk variables of postoperative lower extremity deep venous thrombosis in cervical cancer patients. By univariate analyses, the results of the study showed that the incidence of postoperative DVT was significantly increased in cervical cancer patients complicated with old age, obesity, high preoperative plasma D-dimer level, increased preoperative triglyceride level, chronic diseases (hypertension, diabetes, and cardiovascular disease), open surgery, long operation time, intraoperative blood transfusion, advanced tumor stage, and preoperative chemotherapy/radiotherapy. Advanced age, obesity, elevated preoperative D-dimer level, high preoperative triglyceride level, and open surgery were independent risk factors for postoperative lower extremity DVT in patients with cervical cancer by multivariate regression analyses (all P < .05). In gynecologic patients with cervical cancer, there is a high incidence of postoperative lower extremity DVT. Clinicians should develop systematic and comprehensive prevention and treatment measures for the risk factors to lower this morbidity and improve patient prognosis.

Analysis of risk factors for deep vein thrombosis after spinal infection surgery and construction of a nomogram preoperative prediction model.

To investigate the differences in postoperative deep venous thrombosis (DVT) between patients with spinal infection and those with non-infected spinal disease; to construct a clinical prediction model using patients' preoperative clinical information and routine laboratory indicators to predict the likelihood of DVT after surgery. According to the inclusion criteria, 314 cases of spinal infection (SINF) and 314 cases of non-infected spinal disease (NSINF) were collected from January 1, 2016 to December 31, 2021 at Xiangya Hospital, Central South University, and the differences between the two groups in terms of postoperative DVT were analyzed by chi-square test. The spinal infection cases were divided into a thrombotic group (DVT) and a non-thrombotic group (NDVT) according to whether they developed DVT after surgery. Pre-operative clinical information and routine laboratory indicators of patients in the DVT and NDVT groups were used to compare the differences between groups for each variable, and variables with predictive significance were screened out by least absolute shrinkage and operator selection (LASSO) regression analysis, and a predictive model and nomogram of postoperative DVT was established using multi-factor logistic regression, with a Hosmer- Lemeshow goodness-of-fit test was used to plot the calibration curve of the model, and the predictive effect of the model was evaluated by the area under the ROC curve (AUC). The incidence of postoperative DVT in patients with spinal infection was 28%, significantly higher than 16% in the NSINF group, and statistically different from the NSINF group (P < 0.000). Five predictor variables for postoperative DVT in patients with spinal infection were screened by LASSO regression, and plotted as a nomogram. Calibration curves showed that the model was a good fit. The AUC of the predicted model was 0.8457 in the training cohort and 0.7917 in the validation cohort. In this study, a nomogram prediction model was developed for predicting postoperative DVT in patients with spinal infection. The nomogram included five preoperative predictor variables, which would effectively predict the likelihood of DVT after spinal infection and may have greater clinical value for the treatment and prevention of postoperative DVT.

A Cohort Study of Rivaroxaban Combined with D-Dimer Dynamic Monitoring in the Prevention of Deep Venous Thrombosis after Knee Arthroplasty.

Objective To explore the cohort study of rivaroxaban combined with D-dimer dynamic monitoring in the prevention of deep venous thrombosis (DVT) after knee arthroplasty. Methods Eighty-four patients with knee osteoarthritis who went through total knee arthroplasty from June 2019 to June 2021 in our hospital were arbitrarily assigned into the study group and the control group. The patients in the control group were cured with rivaroxaban anticoagulation after operation, and the study group was cured with dynamic monitoring of D-dimer on the basis of the control group. The incidence of postoperative DVT, pulmonary embolism (PE), and bleeding complications (incision ecchymosis and bleeding events) were compared. The related indexes such as drainage volume and blood transfusion volume were compared. The levels of activated partial prothrombin time (APPT), prothrombin time (PT), and D-dimer were dynamically monitored before and after operation. Visual analogue scale (VAS) was adopted to assess the degree of postoperative incision pain, the level of limb swelling before and after operation was measured, the circumference difference of affected limb was calculated, the ecchymosis area was assessed in the form of nine-palace grid, and the scores were compared. Results According to the comparison of VAS score, there exhibited no remarkable difference before operation and on the first day after operation, but the VAS score decreased after operation, and the VAS score of the study group on the 3rd day, 7th day, and 14th day after operation was remarkably lower compared to the control group (P < 0.05). There exhibited no remarkable difference in drainage volume (P > 0.05), but the blood transfusion volume and total blood loss in the study group were remarkably lower (P < 0.05). There exhibited no remarkable difference in the level of PT on the 3rd day before operation and on the 3rd day after operation, but on the 7th day and 14th day after operation, the level of PT in the study group was remarkably higher (P < 0.05). The level of PT in the study group was remarkably higher (P < 0.05). There exhibited no remarkable difference in the level of APPT on the 3rd day before operation and on the 3rd day after operation, but on the 7th day and 14th day after operation, the level of APPT in the study group was remarkably higher (P < 0.05). The level of APPT in the study group was remarkably higher (P < 0.05). There exhibited no remarkable difference in the level of plasma D-dimer before operation (P > 0.05). The level of plasma D-dimer in the study group was lower (P < 0.05). In terms of the postoperative ecchymosis area score, the ecchymosis area score decreased remarkably after operation. Furthermore, the ecchymosis area score of the study group was remarkably lower (P < 0.05). In terms of the swelling degree of the affected limb, there exhibited no remarkable difference in thigh circumference and calf circumference before operation (P > 0.05), but after operation, the thigh circumference difference and calf circumference difference decreased, and the thigh circumference difference and calf circumference difference in the study group were lower (P < 0.05). The incidence of DVT in the study group was 16.67%, while that in the control group was 38.10%. No PE occurred in the two groups at the early stage after operation. There were 3 cases of incision ecchymosis, 1 case of bleeding event (incision oozing) in the study group, 11 cases of incisional ecchymosis, and 2 cases of bleeding event in the control group. In 3 patients with incisional bleeding, there were no obvious abnormalities in routine blood examination and blood coagulation indexes. The patients were given wound pressure bandaging and stopped using anticoagulants and changing wound dressings every day, all of which disappeared within 5 days. The incidence of early postoperative DVT and bleeding complications in the study group was lower (P < 0.05). Conclusion Rivaroxaban combined with D-dimer dynamic monitoring has high clinical value in preventing DVT after knee arthroplasty and can effectively reduce the amount of blood loss during operation and the incidence of postoperative DVT, PE, and bleeding complications, which is worth popularizing to reduce the area of ecchymosis and the degree of pain after operation and shorten the recovery process.

Not Using a Tourniquet May Reduce the Incidence of Asymptomatic Deep Venous Thrombosis After ACL Reconstruction: An Observational Study.

Background:Deep venous thrombosis (DVT) and pulmonary embolism are serious potential complications after anterior cruciate ligament reconstruction (ACLR). Little is known about the influence of tourniquet use on the incidence of DVT after ACLR.Purpose:To compare the incidence of DVT after ACLR with and without the use of a tourniquet.Study Design:Cohort study; Level of evidence, 3.Methods:Between November 2018 and May 2020, a total of 60 consecutive ACLRs in 60 patients, including 7 revision surgeries, were performed without tourniquet use at our hospital and were enrolled in this study (T– group). In addition, 55 consecutive ACLRs in 55 patients, including 10 revision surgeries, were performed with tourniquet use between April 2017 and September 2018 and were enrolled as the control group (T+ group). DVT was diagnosed using ultrasonography of both legs performed preoperatively and at postoperative week 1. The incidence of postoperative DVT was compared between the T– and T+ groups. Logistic regression analysis was performed to evaluate the effect of older age (≥40 vs <40 years) and tourniquet use on the occurrence of DVT.Results:No DVTs were detected preoperatively. The incidence of postoperative DVT was significantly lower in the T– group compared with the T+ group (1 patient [1.7%] vs 9 patients [16.4%]; P = .005). All patients with DVT were asymptomatic. Although the mean operative time was not significantly different (80.8 minutes in the T+ group vs 78.5 minutes in the T– group; P = .461), the mean blood loss from the drain was significantly lower in the T– group than in the T+ group (149.9 vs 201.9 mL; P < .001). Age ≥40 years and tourniquet use were significantly related to the occurrence of DVT (odds ratio, 8.3 [95% CI, 1.9-36.8]; P = .005; and odds ratio, 8.8 [95% CI, 1.0-75.3]; P = .047, respectively).Conclusion:ACLRs performed without tourniquet resulted in a significantly lower incidence of DVT after ACLR and significantly less bleeding from drains. If adequate visibility of the surgical field is obtained, ACLR without tourniquet use may reduce the incidence of DVT.

Frequency and Risk Factor of Lower-limb Deep Vein Thrombosis after Major Orthopedic Surgery in Vietnamese Patients.

BACKGROUND:Deep venous thrombosis (DVT) is a prevalent complication of orthopedic surgery. According in many studies. The incidence of DVT may be up to 50% if thromboprophylaxis is not available.AIM:The objective of this study was to check the degree of disease, clinical characteristics and analyzed factors in vulnerabilities with lower-limp DVT after orthopedic surgery in a Vietnam teaching hospital.METHODS:Orthopedic patients who met criteria were recruited at our hospital between August 2017 and June 2018. Ultrasound was used to discovering lower-limp DVT in pre-surgery and 7 days after surgery in all patients.RESULTS:The incidence of DVT after orthopedic surgery was 7.2%. Patients with older age (> 60) have a risk of 2 times higher of DVT after surgery than normal people (p < 0.05). The incidence of postoperative DVT was higher in immobile individuals > 72 hours (p < 0.05). Patients with prolonged surgical time (>120 minutes) had a higher risk of postoperative DVT than non-surgical patients’ surgery (p < 0.05).CONCLUSIONS:DVT remains a common complication following orthopedic surgery. Older age, immobility status, and surgical time have been found to be risky factors for the development of postoperative lower-limp DVT in orthopedic patients.

Analysis of occurrence regularity and risk factors of deep venous thrombosis in patients with distal fractures of the knee during perioperative period

Objective To investigate the occurrence of deep venous thrombosis (DVT) in the perioperative period of patients with fracture distal to the knee, so that clinicians have a better understanding of the occurrence of DVT in the perioperative period of the fracture distal to the knee. Methods A retrospective analysis of the clinical data of 365 patients with distal knee fractures who underwent surgery in the Department of Orthopaedics Trauma, Xi′an Jiaotong University Medical College Red Cross Hospital from June 2014 to March 2018 was conducted. There were 213 males and 152 females, aged (45.05±15.24) years, with an age range of 17-83 years. Classification of fracture sites: 177 cases of tibiofibular shaft fracture, 130 cases of ankle fracture, and 58 cases of foot fracture. According to whether thrombosis occurred or not, the patients were divided into thrombotic group and non-thrombotic group before and after operation. There were 66 patients with thrombosis before operation, 299 patients without thrombosis before operation, 88 patients with thrombosis after operation, and 277 patients without thrombosis after operation. The incidence of thrombosis and the location of the thrombus were recorded. The sex, age, fracture site, ASA score, operation time, the time from injury to admission, the time from injury to surgery, intraoperative tourniquet time, intraoperative blood transfusion volume, intraoperative blood loss, intraoperative transfusion volume, hemoglobin volume at admission and 1 day after operation, D-dimer level at admission and 1 day after operation, multiple injuries, chronic hepatitis and medical diseases were analyzed. The measurement data of normal distribution and homogeneity of variance were expressed as mean±standard deviation (Mean±SD), the t test was used for comparison between two groups. The comparison of count data was performed by χ2 test or Fisher exact probability method, and multivariate logistic regression analysis was performed on the risk factors affecting the occurrence of DVT in both lower extremities. Results The preoperative DVT rate was 18.1% (66/365). In patients with thrombosis, distal thrombosis accounted for 93.94% (62/66), and mixed thrombosis accounted for 6.06% (4/66). The incidence of postoperative DVT was 24.1% (88/365). In patients with thrombosis, distal thrombosis accounted for 94.32% (83/88), proximal thrombosis accounted for 1.14% (1/88), and mixed thrombus accounted for 4.55% (4/88). Fracture site, ASA score, operation time, intraoperative tourniquet time, intraoperative blood transfusion volume, intraoperative blood loss, intraoperative transfusion volume were not statistically significant(P>0.05). Age ≥ 40 years (OR=2.691, 95% CI: 1.422-5.093, P=0.002), the time from injury to admission>3 days (OR=1.927, 95%CI: 1.072-3.463, P=0.028) were independent risk factors for DVT formation in fracture distal to the knee before operation. Age ≥ 40 years (OR=3.925, 95% CI: 2.161-7.129, P=0.000), the time from injury to surgery >5 days (OR=1.835, 95%CI: 1.080-3.119, P=0.025), D-dimer level at 1 day after operation (OR=1.191, 95%CI: 1.096-1.293, P=0.000), combined with multiple injuries (OR=1.981, 95%CI: 1.006-3.902, P=0.048), combined with coronary atherosclerotic heart disease (OR =2.692, 95%CI: 1.112-6.517, P=0.028) were independent risk factor for DVT formation after operation for fracture distal to the knee. Conclusions The occurrence of DVT before and after the fracture of the knee is mainly caused by distal thrombosis, and proximal thrombosis also occurs. Those patients aged≥40 years, combined with multiple injuries and coronary heart disease, should focus on preventing the occurrence of DVT. After the injury, the patient is immediately admitted to the hospital for DVT screening, and when the general condition allowed, shortening the preoperative waiting time can reduce the occurrence of DVT. Key words: Fracture; Venous thrombosis; Risk factors

Blood Viscosity Response to Specific Electrical Acupoint Stimulation Post Colorectal Tumor Surgery.

Lower deep venous thrombosis (DVT) is one of the major complications of patients with tumors or patients undergoing major surgery. Electrical acupoint stimulation, an established technique of traditional Chinese medicine, can be well combined with Western medicine to reduce the incidence of postoperative DVT, especially in elderly patients1. Purpose: The purpose of the study was to determine the effect of electrical acupoint stimulation on blood viscosity of patients undergoing colorectal tumor surgery. Subjects and Methods: Thirty patients who had malignant colorectal tumor stage A ,B,C and D undergoing elective surgery for that tumor selected randomly and divided into two equal groups. Group 1 include 15 patients that received standard traditional physical therapy postoperative care from the first day after surgery for 1 week. Group 2 include 15 patients who received the same treatment as group1 plus electrical acupoint stimulation from the first day after surgery for 1 week. Blood viscosity in both groups were assessed using platelet count, prothrombine concentration and color duplex study of the blood flow velocity in the veins of lower limbs. Results: The results of this study showed significant decrease in the blood viscosity of lower limb veins in the group 2 that used electrical acupoint stimulation over group 1(P value < 0.001) . Conclusion: It was concluded that electrical acupoint stimulation is an effective method to increase blood viscosity and hence decrease the incidence of DVT after colorectal tumor surgery.

Diagnosis and Management of Venous Thrombosis in the Surgical Patient

Deep venous thrombosis (DVT) continues to be a source of major morbidity and mortality for surgical patients. The incidence of postoperative DVT is as high as 28% in some series. Risk factors include immobility, venous endothelial injury, stasis, and advanced age, all of which are highly prevalent in many populations of surgical patients. Diagnosis is generally confirmed by using duplex ultrasound to examine the legs. This modality has largely replaced contrast venography as the gold standard imaging test for DVT. Treatment begins with heparin and warfarin. Recently, low-molecular-weight heparin (LMWH) has been shown to be a suitable alternative to conventional, unfractionated heparin as the initial anticoagulant treatment of DVT. This change permits outpatient treatment of DVT in suitable patients. However, anticoagulation is contraindicated in many postoperative patients, who may then require an inferior vena caval filter. Iliofemoral venous thrombectomy should be considered when postoperative patients present with phlegmasia cerulea dolens. Long-term management of these patients focuses on measures to prevent clinical manifestations of chronic venous insufficiency.

Changes in coagulation and fibrinolysis after total hip replacement and their relations with deep vein thrombosis.

Postoperative changes related to coagulation and fibrinolysis and their correlation with the incidence of deep venous thrombosis (DVT) were studied in 30 patients undergoing total hip replacement. Pre- and postoperative measurements of fibrinogen, factor Xa, VIII:C, VIIIR:Ag and its electrophoretic mobility, antifactor Xa activity, antithrombin III (AT III) and its electrophoretic mobility in plasma and serum, fibrin monomers, euglobulin lysis time, fibrinogen degradation products (FDP), alpha 2-antiplasmin and plasmin-antiplasmin complexes were determined. DVT was detected by 125I-fibrinogen leg scanning in 11 patients. There was a significant and progressive increase in fibrinogen, VIII:C, VIIIR:Ag, fibrin monomers, FDP and alpha 2-anti-plasmin levels after operation and likewise a prolongation of euglobulin lysis time. There were changes in electrophoretic mobility of AT III in plasma and serum in 12 patients. The presence of plasmin-antiplasmin complexes was demonstrated in 9 patients. No correlation between the changes in coagulation and fibrinolysis and the incidence of postoperative DVT was found. We conclude that important changes occur in several parameters of coagulation and fibrinolysis after total hip replacement. Such changes are not related to the development of postoperative DVT.