Venous Thrombosis Of Lower Extremities Research Articles

ROLE OF SERUM HOMOCYSTEINE AND VENOUS DOPPLER ULTRASONOGRAPHY IN VENOUS INSUFFICIENCY IN BEHCET'S DISEASE AT ZAGAZIG UNIVERSITY HOSPITALS

Background: Lower extremity venous thrombosis (LEVT) is the most frequent form of vascular involvement in Behcet's disease. Up to 17% of the mortality in Behcet's disease is reported to be associated with venous involvement such as pulmonary embolism or Budd–Chiari syndrome (BCS). Early recognition and appropriate management of vascular involvement in BD is essential to reduce associated morbidity and mortality. Homocysteine (hcy) may play a role in BD patient with venous affection. Objectives: To find out the role of homocysteine and venous Doppler ultrasonography in detection of venous insufficiency (VI) in BD patients. Subjects and Methods: A case control study, 50 patients with Behcet's diseaseand 50 age and sex matched healthy controls were included. Serum homocysteine (by ng/l) was determined by ELISA. Also measurement of VI by venous Doppler ultrasonography in lower limbs of Behcet's patients and controls. Results: In this study there was statistically significant difference between serum homocysteine level among BD patients and controls (p < 0.05). There was a significant difference between serum homocystiene levels in BD patients with venous versus non venous affections, p<0.05. There was a significal positive correlation between serum hcy levels and VI grades by Doppler US. Conclusions: Behcet's disease patients with hyperhomocysteinaemia and VI diagnosed by Power Doppler US should be considered as a strong indicator of pathological venous involvement.

An Acute Pulmonary Embolism Patient with Negative D-dimer Masquerading as Right Pneumonia with Pleural Effusion Proven by CT Pulmonary Arteriography: a Case Report and Literature Review

We report an acute pulmonary embolism with negative D-dimer masquerading as right pneumonia with pleural effusion proven by CT pulmonary arteriography (CTPA). Appropriate laboratory tests are carried out. The application of vascular ultrasound for the cause of left lower extremity edema. CTPA were performed when vascular ultrasound suggested the existence of venous thrombosis of left lower extremity. Serum D-dimer was negative. Vascular ultrasound revealed left lower extremity venous thrombosis, CTPA demonstrated large emboli in the main pulmonary artery and main pulmonary artery branches. Negative serum D-dimer is not safe to rule out acute pulmonary embolism. When CT shows peripheral triangle-shaped infiltrate with pleuritis or small pleural exudate, physicians should pay attention to pulmonary infarction.

Treatment of avascular necrosis of femoral head in patients with human immunodeficiency virus infection by cementless total hip arthroplasty

To investigate the effectiveness of cementless total hip arthroplasty (THA) in treatment of avascular necrosis of the femoral head (ANFH) in patients with human immunodeficiency virus (HIV) infection. The clinical data of 22 patients (35 hips) with HIV infection and ANFH (positive group), who were treated with cementless THA between February 2014 and January 2017, was retrospectively analyzed. Tirty-three cases (43 hips) without HIV infection, who were treated with cementless THA during the same period, were collected as control (negative group). There were significant differences in the age, gender, incidence of bilateral ANFH, and disease duration between 2 groups ( P<0.05). There was no significant difference in the Ficat stage of ANFH between 2 groups ( P>0.05). The operation time, intraoperative blood loss, rate of blood transfusion, postoperative complications, and hospitalization time were recorded. The hip joint function was evaluated by Harris score and X-ray film was performed to observe the position of the prosthesis. The follow-up time was 13-24 months (mean, 20.2 months) in positive group and 14-25 months (mean, 21.6 months) in negative group. The operation time of negative group was significantly shorter than that of positive group ( t=3.677, P=0.001). However, there was no significant difference in intraoperative blood loss, rate of blood transfusion, and hospitalization time between 2 groups ( P>0.05). There was no significant difference in Harris score between 2 groups before operation and at 1, 3, 6, and 12 months after operation ( P>0.05). There were 2 cases of superficial infection of incision and 1 case of pulmonary infection during hospitalization in positive group, and 1 case of superficial infection of incision and 1 case of venous thrombosis of lower extremity in negative group. No death or loosening and sinking of the prosthesis occurred in both groups during follow-up. Cementless THA is a safe and effective method for ANFH in patients with HIV infection.

Management of Extremity Venous Thrombosis in Neonates and Infants: An Experience From a Resource Challenged Setting.

We aimed to evaluate the outcome of different treatment modalities for extremity venous thrombosis (VT) in neonates and infants, highlighting the current debate on their best tool of management. This retrospective study took place over a 9-year period from January 2009 to December 2017. All treated patients were referred to the vascular and pediatric surgery departments from the neonatal intensive care unit. All patients underwent a thorough history-taking as well as general clinical and local examination of the affected limb. Patients were divided into 2 groups: group I included those who underwent a conservative treated with the sole administration of unfractionated heparin (UFH), whereas group II included those who were treated with UFH plus warfarin. Sixty-three patients were included in this study. They were 36 males and 27 females. Their age ranged from 3 to 302 days. Forty-one (65%) patients had VT in the upper limb, whereas the remaining 22 (35%) had lower extremity VT. The success rate of the nonsurgical treatment was accomplished in 81% of patients. The remaining 19% underwent limb severing, due to established gangrene. The Kaplan-Meier survival method revealed a highly significant increase in both mean and median survival times in those groups treated with heparin and warfarin compared to heparin-only group (P < .001). Nonoperative treatment with anticoagulation or observation (ie, wait-and-see policy) alone may be an easily applicable, effective, and a safe modality for management of VT in neonates and infants, especially in developing countries with poor or highly challenged resource settings.

Clinical Application of Percutaneous Transluminal Angioplasty and Stent Implantation in Acute Lower Extremity Deep Venous Thrombosis

Purpose: To analyze the application of percutaneous transluminal angioplasty and stenting in acute deep venous thrombosis of lower extremities. Methods: 70 patients were divided into two groups according to the presence or absence of percutaneous transluminal angioplasty and stenting. Results: The mean circumferential diameter difference between the affected limbs and the healthy limbs and the knees at 15 cm was statistically significant. The cure rate and effective rate of the research group were higher than those of the control group (P&lt;0.05). Conclusion: Percutaneous transluminal angioplasty and stenting are of high value in acute lower extremity deep venous thrombosis.

Expression variations and clinical significance of MMP-1, MMP-2 and inflammatory factors in serum of patients with deep venous thrombosis of lower extremity.

Expression levels and clinical significance of matrix metalloproteinase-1 (MMP1), MMP-2 and inflammatory factors in the serum of patients with deep venous thrombosis (DVT) of lower extremity were investigated. Fifty untreated DVT patients were selected as the DVT group, and 50 patients undergoing health examination were enrolled as the normal control group. Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of MMP-1, MMP-2, interleukin-6 (IL-6), IL-8 and tumor necrosis factor-α (TNF-α) in the serum. Western blotting was adopted to detect the expression levels of MMP-1 and MMP-2 proteins. Fluorescent reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was applied to examine the messenger ribonucleic acid (mRNA) expression levels. Moreover, the circumferences of the patients were measured. The difference between the circumference of affected extremity and unaffected extremity was calculated. Correlation analysis was conducted separately for the levels of serum MMP-1, MMP-2, IL-6, IL-8 and TNF-α of patients in the DVT group. In the DVT group, the levels of MMP-1, MMP-2, IL-6, IL-8, and TNF-α at 7 days after treatment were significantly lower than those before treatment (P<0.01). Compared with that before treatment, the circumference difference of the affected and unaffected extremities of the patients was reduced at 7 days after treatment (P<0.01). The levels of IL-6, IL-8 and TNF-α were positively correlated with the levels of MMP-1 and MMP-2, respectively in the DVT group (P<0.05 or P<0.01). MMP-1, MMP-2 and inflammatory factors play an important role in the occurrence and development of DVT, of which the levels of IL-6, IL-8 and TNF-α are positively correlated with the levels of MMP-1 and MMP-2, respectively. Therefore, monitoring the concentration of MMP-1, MMP-2 and inflammatory factors is of significant value for the diagnosis, progression and judgement of treatment effect of DVT in clinical practice.

Venous thrombosis in unusual sites: A practical review for the hematologist.

Thrombosis of unusual venous sites encompasses a large part of consultative hematology and is encountered routinely by practicing hematologists. Contrary to the more commonly encountered lower extremity venous thrombosis and common cardiovascular disorders, the various thromboses outlined in this review have unique presentations, pathophysiology, workup, and treatments that all hematologists should be aware of. This review attempts to outline the most up to date literature on cerebral, retinal, upper extremity, hepatic, portal, splenic, mesenteric, and renal vein thrombosis, focusing on the incidence, pathophysiology, provoking factors, and current recommended treatments for each type of unusual thrombosis to provide a useful and practical review for the hematologist.

Analysis of the Incidence of Lower Extremity Venous Thrombosis and Its Related Risk Factors in Admitted Patients with Lung Cancer

背景与目的静脉血栓栓塞症（venous thromboembolism, VTE）是一种公认的在肺癌患者中有较高发病率和死亡率的并发症。本研究目的是明确我们中心肺癌患者入院时下肢深静脉血栓（lower extremity venous thrombosis, LEDVT）的发生率，并揭示其入院时LEDVT发生的危险因素。方法选择天津医科大学总医院肺部肿瘤外科在2017年7月-2017年12月收治的231例肺癌患者，入院时即行双下肢静脉彩超检查，以分析肺癌患者LEDVT的发生率；同时，对肺良性疾病患者入院时LEDVT的发生率进行比较。在肺癌患者中，进一步分析LEDVT发生与其临床特征的关系，寻找LEDVT发生的可能危险因素；同时，亦分析这些患者的血浆D-二聚体（D-Dimmer）、纤维蛋白原（fibrinogen, FIB）、凝血酶时间（thrombin time, TT）、活化部分凝血酶时间（activated partial thrombin time, APTT）、凝血酶原时间（prothrombin time, PT）及血小板（platelet, PLT）之间的差异。结果在231例肺癌患者中，入院时发生LEDVT者12例，其发生率为5.2%（12/231）；而77例肺良性疾病患者入院时均未查见LEDVT的发生，提示肺癌患者入院时LEDVT的发生率明显高于肺良性疾病（P < 0.05）。在肺癌患者中进一步分析发现，伴有远处转移（包括N3淋巴结转移）的肺癌患者较不伴有转移者更易发生LEDVT（11.29%, 7/62 vs 2.96%, 5/169）（P < 0.05）。肺癌LEDVT组患者入院时的D-Dimer的中位值为1, 534mg/L（369 mg/L-10, 000 mg/L），明显高于非LEDVT组患者(539 mg/L, 126 mg/L-1, 000 mg/L)（P < 0.05）；而FIB、TT、APTT、PT和PLT在两组患者之间无明显统计学差异（P > 0.05）。结论我们中心肺癌患者入院时LEDVT总体发生率约为5%，明显高于肺良性疾病患者。入院时伴有远处转移（包括N3淋巴结转移）的肺癌患者更易发生LEDVT，其中，D-Dimer值较高的患者应考虑到VTE事件发生的可能。

Limited orthopaedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis

To summarize the effectiveness of limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis, and then to explore the strategy of surgical correction and functional reconstruction method. From the database of 23 310 cases of poliomyelitis sequelae treated by QIN Sihe Orthopaedic Surgical team between September 1982 and December 2017, 629 patients over 41 years old were retrieved and the epidemiological characteristics of the patients were analyzed. Between March 2011 and June 2015, 57 patients with poliomyelitis sequelae treated with limited operation and external fixation were followed up 2-6 years, and the history of poliomyelitis sequelae was 41-67 years (mean, 47.1 years). Preoperative histopathological gait included 29 cases of quadriceps gait, 17 cases of walking with crutch, and 11 cases of claudication only. The operative methods included Achilles tendon lengthening in 52 cases, supracondylar osteotomy in 39 cases, knee flexion release in 36 cases, calcaneal arthrodesis in 27 cases, flexion and hip arthrodesis in 21 cases, tibia and fibula osteotomy in 19 cases, triple arthrodesis in 11 cases, and tendon transposition in 1 case. After operation, 18 cases were treated with combined external fixator and 39 cases with Ilizarov ring external fixator. Of the 629 cases, 481 cases were less than 50 years old (76.47%), accounting for 144 cases between 51 and 65 years old (22.89%). Among them, 495 cases (78.70%) were diagnosed after 2003. Of the 57 patients obtained complete follow-up information, 7 had slight infection of needle path during traction orthopaedics, 2 had early postoperative venous thrombosis of lower extremities, and 2 had incomplete paralysis of the common peroneal nerve. There was no complications such as skin incision infection, vascular injury, and bone nonunion. According to the evaluation standard of postoperative efficacy standard in correction of lower extremity deformities, the results were excellent in 23 cases, good in 20 cases, fair in 12 cases, and poor in 2 cases, with an excellent and good rate of 75.44%. The 2 patients with poor effectiveness were reoperated to improve their function. Limited orthopedic surgery combined with external fixation for the treatment of lower extremity sequelae of middle and old aged post-poliomyelitis can effectively correct deformities of lower limbs, improve function, delay the disability aggravated by decay, and avoid serious complications.

Clinical prospective comparative study on short-term effectiveness of arthroscopic treatment of popliteal cyst between cyctectomy and internal drainage combined with cyctectomy

To compare the short-term effectiveness between arthroscopic cystectomy and internal drainage combined with cystectomy in popliteal cyst. Between March 2014 and March 2017, 56 patients with symptomatic popliteal cyst were enrolled in the study, randomized block design was used to divided the patients into trial group (arthroscopic cystectomy combined with internal drainage group, n=28) and control group (arthroscopic internal drainage group, n=28). Excluding those who had incomplete follow-up and received surgery for other diseases postoperatively, 26 patients in the experimental group and 27 patients in the control group were finally enrolled in the study. There was no significant difference in gender, age, side, course of disease, maximum diameter and grade of popliteal cyst, and associated diseases between two groups ( P>0.05). The operation time, duration of popliteal ecchymosis and the middle back of calf tenderness were observed postoperatively. The circumference of calf at 1 day, 1 week, and 2 weeks after operation were measured and the differences were calculated with the measurement before operation. Lower extremity venous thrombosis was observed by color doppler ultrasonography at 1 week after operation. The effectiveness was evaluated by Rauschning and Lindgren grading criteria. And MRI was used to observe whether the popliteal cyst disappeared or decreased and measured its maximum diameter at 1 year after operation. Patients in both groups were followed up 12-14 months, with an average of 12.5 months. The operation time, duration of popliteal ecchymosis, and the middle back of calf tenderness of the trial group were all longer than those in the control group ( P<0.05), the differences of circumference of calf at 1 day, 1 week, and 2 weeks after operation of the trial group were greater than those in the control group ( P<0.05). Color doppler ultrasonography of the lower extremity at 1 week after operation found that the intermuscular venous thrombosis occurred in 2 cases of the trial group, while no lower extremity thrombosis was found in the control group; and the difference between two groups was not significant ( P=0.236). According to the Rauschning and Lindgren grading criteria, there were 16 cases of grade 0, 6 cases of grade 1, and 4 cases of grade 2 in the trial group, and 17 cases of grade 0, 4 cases of grade 1, and 6 cases of grade 2 in the control group at 1 year after operation. There was no significant difference between 2 groups ( Z=-1.872, P=0.078). Nine cases (34.62%) of the trial group and 13 cases (48.15%) of the control group still have residual cysts by MRI, the maximum diameter of which was less than 2 cm. The cysts disappeared in the remaining patients in both groups, and there was no recurrence during the follow-up. There was no significant difference in cyst residual rate between 2 groups ( χ2=2.293, P=0.852). Compared with arthroscopic internal drainage, the short-term effectiveness of the arthroscopic internal drainage combined with cystectomy had no significant improvement, and the operation time was prolonged, the postoperative complications were obviously increased.

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

Objective To explore the causes of deep venous thrombosis of the lower extremities after femoral neck fracture. Methods To retrospectively analyze the clinical data of 483 cases of femoral neck fractures treated from September 2014 to December 2017 from Department of Traumatic Orthopedics, Xi′an Jiaotong University School of Medicine Affiliated Honghui Hospital. Please record the patient′s complications, blood transfusion volume, reduction method, internal fixation, operative time, intraoperative blood loss, and postoperative thrombosis. Count data were expressed as percentage(%) and analyzed by χ2 test between the two groups; measurement data were expressed as (±s), and two independent samples was used by t test. To calculate the incidence of postoperative deep venous thrombosis in patients with femoral neck fractures and to investigate the causes of deep vein thrombosis of the lower extremities after femoral neck fractures. Results Of the 483 patients, 149 cases of deep vein thrombosis of the lower extremities occurred after surgery, with an incidence of 30.8%. The reduction method, internal fixation, and intraoperative blood loss all affected the occurrence of deep venous thrombosis after femoral neck fracture (P<0.05). Among the reset methods, 367 cases were open and closed, 33.2% (122/367) had deep venous thrombosis, closed reduction was 116 cases, and 23.3%(27/116) had deep venous thrombosis. The incidence of open reduction deep venous thrombosiswas higher than closed reduction; among the internal fixation methods, fixation, the incidence of deep venous thrombosis after total hip arthroplasty and intramedullary nailing was the highest, which was 52.8% and 50.0%, respectively. The hemorrhage volume in the thrombosis group (246.9±178.1) ml was higher than that in the non-thrombosis group(206.3±126.7) ml. Conclusions The incidence of deep venous thrombosis after femoral neck fractures is high, and the way of reduction, internal fixation, bedtime before operation, and blood loss during operation can affect the occurrence of deep venous thrombosis after femoral neck fracture. There are many factors affecting deep venous thrombosis after femoral neck fracture. It is necessary to fully evaluate the risk of deep venous thrombosis after operation. Key words: Femoral neck; Fractures, bone; Lower extremity; Venous thrombosis

Risk and prognosis of cancer after upper-extremity deep venous thrombosis: A population-based cohort study

Introduction: The association between lower-extremity venous thrombosis and cancer is well-established. However, the extent to which upper-extremity deep venous thrombosis (U-DVT) is a marker of cancer and a prognostic factor for all-cause mortality remains poorly understood.

1108 - Frequency and predictive factor of deep venous thrombosis of lower extremities in patients with elevated serum D-dimer before surgery for urologic malignancy

1108 - Frequency and predictive factor of deep venous thrombosis of lower extremities in patients with elevated serum D-dimer before surgery for urologic malignancy

Analysis of the occurrence of deep venous thrombosis in lower extremity fractures: A clinical study.

Objective:To clarify if fracture site is correlated to the occurrence of deep venous thrombosis, and determine the risk factors of deep venous thrombosis in lower extremity fractures, help surgeons make prophylaxis for the disease correctly.Methods:The patients with lower extremity fractures treated surgically in the orthopedics department of our hospital from May 2012 to July 2017 were reviewed retrospectively. The clinical data including age, gender, fracture site, surgery modality, hospital stay, operation time, occupation type, hypertension, coronary heart disease, diabetes, smoking status, drinking status, postoperative exercises were collected and analyzed.Results:Eight hundred and twenty-nine patients were included for analysis, in which 68 were included in deep venous thrombosis group, 761 were included in the non-deep venous thrombosis group, and the incidence of deep venous thrombosis was 8.2%. There were significant differences in age, fracture site, surgery modality, occupation type, operation time, smoking status, hospital stay and postoperative exercises between the two groups (p<0.05), but no significant differences in gender, drinking status, coronary heart disease, diabetes and hypertension (p>0.05). In multivariate analysis, old age greater than 50 years, arthroplasty and operation time more than three hours were independent risk factors, while physical labor and postoperative exercises were protective factors for deep venous thrombosis in lower extremity fractures.Conclusion:Fracture site was correlated to the incidence of deep venous thrombosis, old age, longer operation time, and arthroplasty were independent risk factors, physical labor and postoperative exercises were protective factors for deep venous thrombosis in patients with lower extremity fractures.

Advances in Operative Thrombectomy for Lower Extremity Venous Thrombosis.

Lower extremity deep venous thrombosis is a leading cause of morbidity and mortality. The mainstay of therapy is medical. However, anticoagulation does not remove the thrombus and restore venous patency. In select patients, early thrombus removal and anticoagulation can restore venous patency, preserve venous valve function, and may reduce the incidence of postthrombotic syndrome. Catheter-directed therapies are minimally invasive with low complication rates. However, in patients with a contraindication to thrombolytic agents who can receive anticoagulation, open thrombectomy should be considered if indications for thrombus removal are met and patients are good operative risks.

Pattern Analysis of Lower Extremity Venous Thrombosis: Implications for Point of Care Ultrasound (POCUS) Protocols

Introduction Emergency department point-of-care ultrasound (POCUS) can identify lower extremity venous thrombosis (LEVT) with a published accuracy is 85–90%. The aim of this study was to compare the patterns of LEVT with protocol results and determine the clinical impact of the study results. Methods Patterns of superficial venous thrombosis(SVT) and deep venous thrombosis (DVT) were collated from positive venous duplex ultrasound (VDU) studies. Each pattern was mapped to the potential findings by the described POCUS protocols. Analysis of the literature was used to identify the potential clinical impact of the findings and the functional efficacy of each strategy and a numerical result was developed. Results One hundred six studies were positive for DVT (42), SVT (44), or both (20) on VDU. Patterns for DVT (single or multiple levels and unilateral or bilateral) and SVT (great saphenous vein above and/or below knee or small saphenous vein in single, multiple or bilateral and juxta-junctional) were noted. The patterns covered by the “two-area” protocol showed DVT = 80% and SVT = 38%, and by “three-point compression” DVT = 74% and SVT = 0%. Particular areas not covered included proximal disease (iliac and vena cava) and calf DVT and SVT in all areas except juxta-junctional. The potential impact for DVT is high, whereas for SVT it is moderate to low. The functional efficacy of the “two-area” protocol (5.9) exceeds the “three-point compression” strategy (3.7) but falls short of the “gold standard” VDU (10). Conclusion Pattern analysis of venous thrombosis identifies weakness in POCUS strategies; the clinical implications allow for an assignment of the functional efficacy of each study. Knowledge of these findings should inform emergency room POCUS strategies.

Risk and prognosis of cancer after upper-extremity deep venous thrombosis: A population-based cohort study

IntroductionThe association between lower-extremity venous thrombosis and cancer is well-established. However, the extent to which upper-extremity deep venous thrombosis (U-DVT) is a marker of cancer and a prognostic factor for all-cause mortality remains poorly understood. We examined the risk of cancer after a diagnosis of U-DVT compared with cancer risk in the general population. Materials and methodsUsing Danish nationwide population-based medical registries, we identified all patients with first-time U-DVT during 1980–1993 and 2000–2013. Cancer incidence was ascertained using data from the Danish Cancer Registry. We computed standardized incidence ratios (SIRs) calculated as the observed number of cancers relative to the expected number based on national incidence rates by sex, age, and calendar year. We created a matched comparison cohort of cancer patients without U-DVT, to assess the impact of U-DVT on all-cause mortality. ResultsAmong 1087 patients with U-DVT, 232 patients subsequently were diagnosed with cancer, corresponding to an overall SIR of 1.69 (95% confidence interval, 1.48–1.92). During the first 6months following U-DVT, the absolute risk of any cancer was 5.4%, corresponding to a 13-fold elevated SIR. During the subsequent 6–12months and >12months, the SIR remained 2-fold and 1.3-fold elevated, respectively. U-DVT was a prognostic factor for all-cause mortality in patients with lung, prostate, and colorectal cancer during the first 6months of follow-up. ConclusionU-DVT was a marker of cancer. The clinical utility of searching for occult cancer in patients with U-DVT remains unknown.

Incidence and risk factors of deep venous thrombosis of lower extremity in patients with pelvic or ac-etabular fracture

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

Evaluation of anticoagulant therapy after cerebral hemorrhage combined with deep vein thrombosis of lower extremity

Objective To evaluate the efficacy and safety of anticoagulant therapy with low-molecular-weight heparin after cerebral hemorrhage combined with deep vein thrombosis of lower extremity. Methods One hundred and fifty-three cases of deep vein thrombosis of lower extremity after intracerebral hemorrhage were collected of Beijing Tiantan Hospital, Capital Medical University from June 2014 to June 2016. According to whether accepted anticoagulant therapy with low-molecular-weight heparin, the patients were divided into treatment group (n=79) and control group(n=74). Compared the head CT images and the ultrasound of lower extremity venous in the day when admissed to hospital and in the 7th day after treatment. The measurement data was adopted by t test, Chi-square test was adopted in the count data. Results Before the low-molecular-weight heparin therapy, the average bleeding volume in intracerebral was(1.38±0.45) ml for the anticoagulant therapy group. After 7 days of low-molecular-weight heparin therapy, the average bleeding volume in intracerebral was(1.01±0.54) ml, there was no increasing cerebral hemorrhage, with a statistically significant difference(P=0.000). The bleeding volume in intracerebral was(1.47±0.47) ml of control group cases, and after 7 days it became (1.17±0.52) ml, with a statistically significant difference (P=0.000), all these showed that cerebral hemorrhage had significantly absorbed. There was no statistically significant difference between the treatment group and the control group (P=0.123). It explained that anticoagulation was not increased intracranial hemorrhage with low-molecular-weight heparin. ultrasound showed that the lower extremity venous thrombosis was stable or decreased before and after anticoagulant therapy, and the difference was statistically significant (P=0.000), indicating that the anticoagulant therapy was effective. Conclusions It is safe and effective in low-molecular-weight heparin anticoagulant therapy for deep vein thrombosis of lower extremity after intracerebral hemorrhage. But patients need strict screening, and follow the individualized treatment. Key words: Cerebral hemorrhage; Venous thrombosis; Heparin, low-molecular-weight; Anticoagulants

Comparison of Therapeutic Efficacy of Anticoagulation and Its Combination with Catheter-directed Thrombolysis for Deep Venous Thrombosis of Lower Extremities

To investigate the therapeutic efficacy of anticoagulation(AC) and its combination with catheter-directed thrombolysis(CDT) for deep venous thrombosis of lower extremities. One hundred and thirty-nine patients with deep venous thrombosis of early lower extremities treated in our hospital from May 2011 to September 2013 were selected and randomly divided into the AC group(n= 66) and CDT+AC group(n= 73). The thrombolytic effects, adverse reactions, post-thrombotic syndrome (PTS) and quality of life were evaluated. There were no serious adverse events during treatment and after treatment in the 2 groups. Hematomas in 2 cases and gross hematuria in 3 cases were observed in the CDT+AC group. The gums bleed or gross hematuria in 3 cases were observed in the AC group. Compared with the AC group, the number of grade I thrombolysis in CDT+AC group decreased significantly (60.61% vs 9.59%)(P< 0.05), and the number of grade III thrombolysis increased significantly(7.57% vs 49.31%)(P< 0.05). During follow-up, the incidence of PTS in both groups showed increase year by year, and none of the patients had severe PTS. The incidence PTS in CDT+AC group at 12 months and 18 months were lower than those of AC group(17.81% vs 33.33%, 24.66% vs 43.94%)(P< 0.05). Compared with the AC group, the scores of physiological role and vitality in CDT+AC group at 6 months, 12 months and 18 months were higher (P< 0.05). Catheter-directed thrombolysis combined with AC therapy can promote the mitigation of clinical symptoms in patients with DVT of lower extremities and is beneficial to promoting the life quality of patients.