Deep Venous Thrombosis In Postoperative Patients Research Articles

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.

Nomogram for predicting postoperative deep vein thrombosis in patients with spinal fractures caused by high-energy injuries.

Deep venous thrombosis (DVT) is a common complication in patients with spinal fractures caused by high-energy injuries. Early identification of patients at high risk of postoperative DVT is essential for the prevention of thrombosis. This study aimed to develop and validate a prediction model based on a nomogram to predict DVT in patients with spinal fractures caused by high-energy injuries. Clinical data were collected from 936 patients admitted to our hospital between January 2016 and December 2021 with spinal fractures caused by high-energy injuries. Multivariate logistic regression analysis was used to identify the risk factors for postoperative DVT and to develop a nomogram. The predictive performance of the nomogram was evaluated by the receiver operating characteristic (ROC) curve and calibration curve. The incidence of preoperative DVT was 15.38% (144/936). The postoperative incidence of DVT was 20.5% (192/936). The multivariate analysis revealed that age, operation time, blood transfusion, duration of bed rest, American Spinal Injury Association (ASIA) score and D-dimer were risk factors for postoperative DVT. The area under the ROC curve of the nomogram was 0.835 and the calibration curve showed good calibration. The nomogram showed a good ability to predict postoperative DVT in patients with spinal fractures caused by high-energy injuries, which may benefit pre- and postoperative DVT prophylaxis strategy development.

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.

The predictive value of plasminogen activator inhibitor-1, fibrinogen, and D-dimer for deep venous thrombosis following surgery for traumatic lower limb fracture.

Deep venous thrombosis (DVT) is a common postoperative complication in patients with lower limb fractures. This study aims to investigate the predictive value of plasminogen activator inhibitor-1 (PAI-1), fibrinogen (FIB), and D-dimer (D-D) for DVT following lower limb traumatic fracture surgery and to investigate risk factors for DVT. Clinical data of 63 patients who underwent lower limb traumatic fracture surgery in our hospital from September 2018 to March 2019 were retrospectively analyzed. Patients were divided into a DVT group and a non-DVT group. The differences in the levels of plasminogen activator inhibitor-1 (PAI-1), fibrinogen (FIB), and D-dimer (D-D) were compared, and a receiver operating characteristic (ROC) curve was used to analyze their predictive value for DVT following surgery for lower limb traumatic fracture. Multiple logistic regression analysis was used to analyze the risk factors of DVT. The levels of PAI-1, FIB, and D-D in the DVT group were higher on the third day after surgery compared to the pre-surgical levels, and were also higher than those in the non-DVT group (P<0.05). The area under the ROC curve indicated that the predictive values of PAI-1, FIB, D-D, and the combination of these three indicators for DVT were 0.792, 0.429, 0.966, and 0.992, respectively. Patients with preexisting factors including a BMI ≥24 kg/m2 , a history of diabetes, postoperative infection, an abnormal white blood cell count, an abnormal average thrombocytocrit, and abnormal levels of PAI-1, FIB, and D-D had a higher incidence of DVT following surgery compared to patients without these factors (P<0.05). The results of the multivariate logistic regression model analysis showed that the presence of postoperative infection, abnormal white blood cell count, abnormal mean platelet volume, and abnormal levels of PAI-1, FIB, and D-D were independent risk factors affecting postoperative DVT in patients with lower limb fractures (P<0.05). The levels of PAI-1, FIB, and D-D were significantly increased in patients with DVT following surgery for lower limb fractures. Therefore, early monitoring of PAI-1, FIB, and D-D levels, and coagulation function is a good predictive indicator of postoperative thrombosis.

Correlation between Deep Venous Thrombosis and Inflammation in Patients after Implantation of Permanent Pacemaker

The correlation between postoperative deep venous thrombosis (DVT) and inflammation in patients with permanent cardiac pacemaker implantation was analyzed. A total of 130 cases undergoing permanent pacemaker implantation in the 305 Hospital of Chinese PLA and Fuwai Hospital from May 2014 to February 2017 were selected. Of the 130 cases, 60 patients complicated with DVT were selected as the observation group, and the remaining 70 cases without complications of DVT were selected as the control group. The relationship and influence of various factors were explored. The number of patients smoking and the number of subjects with DVT history in the observation group were higher than those in the control group. In the observation group, plasminogen activator inhibitor (PAI)-1: Ag, PAI-1: Ac, thrombin-activated fibrinolysis inhibitor (TAFI): Ag, and TAFI: Ac levels were higher than those in control group (P<0.05). The levels of inflammatory factors of the peripheral blood of the observation group were significantly higher than those of the control group (P<0.05). In the correlation analysis of serum inflammatory factors and coagulation factors, CRP, IL-6, IL-10 were positively correlated with PAI-1: Ag level. Age, BMI, smoking history, number of implanted electrodes, DVT history, duration of immobilization and inflammatory factor levels had independent predictive value on postoperative complicated DVT. The serum inflammatory factors are closely associated with postoperative DVT in patients implanted with permanent cardiac pacemaker, and the serum inflammatory factors are a good reference for the evaluation of DVT.

Application effect of Autar scale on the risk assessment of deep venous thrombosis among postoperative patients

Objective To investigate the effect of Autar scale on the risk assessment of deep venous thrombosis (DVT) among postoperative patients. Methods Using Autar scale to conduct DVT risk assessment on 94 postoperative patients from April 2013 to February 2014. Four days after the surgery, patients were given color doppler ultrasound tests to detect DVT. Results Among fifty low risk patients, one case occurred DVT, with an incidence of 2.00%. Among thirty-seven medium risk patients, three cases occurred DVT, with an incidence of 8.11%. Among seven high risk patients, four cases occurred DVT, with an incidence of 57.14%. The difference between groups was significant (χ2=23.992, P<0.01). The result of Autar scale risk assessment was positively related to the occurrence of postoperative DVT (r=0.373, P<0.05). Conclusions Autar scale can somewhat forecast the occurrence of DVT in postoperative patients. Using Autar scale before surgery is able to instruct the operating room nurses to design predictive nursing interventions for medium and high risk patients and reduce the risk of DVT during the perioperative period. Key words: Deep venous thrombosis; Risk assessment; Autar scale; Preoperative assessment

Deep Venous Thrombosis After Surgery for Inflammatory Bowel Disease: Is Standard Dose Low Molecular Weight Heparin Prophylaxis Enough?

Inflammatory bowel disease (IBD) and colorectal surgery are risk factors for deep venous thrombosis (DVT). The aim of this prospective study was to evaluate the effectiveness of standardized prophylactic low molecular weight heparin (LMWH) therapy in patients who underwent surgery for ulcerative colitis (UC) and Crohn's disease (CD). Since 1999 all patients operated on for colorectal diseases in our institute have received 4,000 IU/day LMWH from the day of operation to discharge. The complete series of patients who had major colorectal surgery from 1999 until 2006 were reviewed for overt DVT episodes. Furthermore, 60 consecutive patients who were admitted for surgery for IBD were prospectively enrolled in the 2004-2006 period. Each patient underwent venous color Doppler ultrasound scan at admission and at discharge. Demographic data, disease activity, and clotting parameters were collected. Data were analyzed with Spearman's correlation test, multiple regression, and receiver operating characteristics (ROC) curves analysis. The rate of DVT in UC patients was significantly higher than in colorectal cancer patients (p = 0.009), and the odds ratio (OR) for postoperative DVT in UC patients was 7.4 (95% CI 1.4-44.4; p = 0.017). Female gender, UC diagnosis, active rectal bleeding, aPTT value, aCL IgM, abeta2 IgM, and pANCA levels significantly correlated with postoperative DVT. At multivariate analysis only aCL IgM levels were found to be independently associated with postoperative DVT (p = 0.05). In conclusion, our study showed that prophylactic therapy with 4,000 IU/day LMWH was not completely effective for the prevention of postoperative DVT in patients with CD, and even less so in those with UC. In these patients, a more tailored prophylactic therapy should be considered, and further randomized controlled trials testing the effectiveness of different prophylactic protocols would be advisable. Furthermore, aCL IgM serum levels might be helpful in identifying IBD patients who are at higher risk of postoperative DVT.

Prospective screening for postoperative deep venous thrombosis in patients undergoing infrainguinal revascularization

Purpose: The incidence of deep venous thrombosis (DVT) in patients undergoing infrainguinal bypass graft procedures has not been well documented, and the need for routine prophylaxis remains controversial. The purpose of this study was to prospectively evaluate the risk of postoperative DVT complicating infrainguinal revascularization. Methods: Seventy-four patients undergoing infrainguinal bypass graft procedures during a 12-month period were prospectively screened for DVT. Bilateral lower extremity venous duplex scan imaging was performed preoperatively and within 1 week and 6 weeks, postoperatively. Routine DVT prophylaxis was not used, with anticoagulation reserved for specific indications. Results: Of the 74 patients screened, three patients (4.1%) had DVT identified on preoperative venous duplex scan imaging and were excluded from the study. Of the remaining 71 patients enrolled, only two patients (2.8%) had postoperative DVT. Postoperative DVT was ipsilateral to the bypass graft extremity in both patients, with involvement of the peroneal vein in one patient and the femoral vein in the other. Although routine prophylaxis was not used, 18 of these patients (25%) were anticoagulated for other indications, with DVT occurring in one patient (5.6%). Of the remaining 53 patients who did not receive postoperative anticoagulation, only one patient (1.8%) had DVT. Conclusions: According to this prospective study, the risk of postoperative DVT in patients undergoing infrainguinal revascularization is low. Routine prophylaxis is not recommended, with postoperative anticoagulation reserved for specific indications. (J Vasc Surg 2000;32:669-75.)

Clinical Utility of Prothrombin Fragment 1+2, Thrombin Antithrombin III Complexes and D-dimer Measurements in the Diagnosis of Deep Vein Thrombosis following Total Hip Replacement

Measurements of prothrombin fragment 1+2 (F1+2), thrombin antithrombin III complexes (TAT) and D-dimer plasma levels have been proposed as non-invasive screening tests to exclude postoperative deep venous thrombosis (DVT). We investigated the diagnostic efficacy of these coagulation activation markers to rule out postoperative DVT in patients undergoing hip surgery under antithrombotic prophylaxis. In this substudy of a randomized double-blind thrombosis prophylaxis trial comparing three doses of desirudin (10, 15 or 20 mg b.i.d.) with unfractionated heparin (5000 IU t.i.d.) we used ELISA procedures to measure F1+2, TAT and D-dimer in 159 patients undergoing total hip replacement at baseline (day 0) and on postoperative days 1, 3 and 6. Bilateral venography was performed in all cases 8-11 days after surgery. For the F1+2 assay sensitivity ranged from 73 to 83% in the three postoperative days investigated, and negative predictive value (NPV) from 68 to 74%. For TAT and D-dimer sensitivity ranged from 71 to 73% and from 71 to 83% and NPV from 61 to 65% and from 61 to 74% respectively. In terms of sensitivity and NPV F1+2 and D-dimer are equivalent and are superior to TAT. However, their accuracy is too low to rule out the presence of DVT after hip surgery under antithrombotic prophylaxis.

The Use of Dihydroergotamine and Heparin in the Prophylaxis of Deep Venous Thrombosis

Three factors leading to the development of postoperative deep venous thrombosis (DVT) are the hypercoagulable state, stasis, and vein wall injury, which occur in patients undergoing surgical procedures. Vein wall injury is thought to occur as a smooth muscle response to surgical trauma in veins distant from the operative site. Heparin and dihydroergotamine (DHE) were combined in an attempt to decrease the hypercoagulable factor and minimize stasis. We believe that by maintaining venous smooth muscle tone, the degree of endothelial damage is also diminished. Low-dose heparin acts through its effect of factor Xa and activation of antithrombin III; DHE selectively increases venous smooth muscle tone to accelerate venous blood flow velocity and minimize venous pooling. The European experience with combination DHE-heparin prophylaxis shows that this combination is more effective than either agent alone, and studies on orthopedic patients have shown that DHE/5,000 is effective in preventing postoperative DVT in this high-risk group. In the US, the Multicenter Trial evaluated postoperative DVT in general surgical patients. The combination of DHE/5,000 was statistically more effective in the prophylaxis of postoperative DVT than placebo (p = 0.0011). The interim results of an ongoing Multicenter Trial on the prophylaxis of postoperative DVT in patients undergoing total hip replacement indicate that DHE/5000 has significant prophylactic efficacy compared to placebo. It is proposed that the mechanism of action of the DHE-heparin combination is synergistic, since all 3 limbs of Virchow's triad are potentially affected.