Deep Vein Thrombosis in Patients Suffering from Hip and Pelvic Fractures

Document Type : Research Paper

Authors

Abstract

I





 
ntroduction: It seems that the rate of deep vein thrombosis in Asia is low. The aim of this study is to investigate the rate of deep vein thrombosis (DVT) among Iranian patients suffering from hip fracture (proximal of femur) and pelvic fracture (acetabulum) and to analyze the risk factors associated with DVT.
Materials and Methods: This clinical trialstudy was done in the Orthopedy Ward of Shahid Kamiab Hospital of Mashhad University of Medical Sciences during the year 2005. A total of 116 consecutive skeletal fracture patients with a mean age of 59.92 years were investigated. Patients divided into two groups of case (44 patients) and control (72 patients). Patients in the case group were treated using a standardized protocol for DVT prophylaxis (Enaxaparin; 40 mg by subcutaneous injection, once daily) within 24 hours of injury after establishing haemodynamic stability. Control group received no drugs or treatment. Duplex ultrasound was done 9 days and 3-6 weeks after admission. Personal data, previous history of general and heart diseases and radiology results were collected in questionnaire and analyzed using descriptive statistics.
Results: The mean age of patients with DVT was 63.5 years (standard deviation [SD], 11.22 years). The mean age of patients without DVT was 58.64 years (SD, 14.74 years). Four patients (9.1%) showed DVT in spite of chemoprophylaxis. There was significant relation between the both groups (p=0.021).
Conclusion: Results show that the incidence of DVT after acute hip and pelvic fracture in Iranian traumatized patients was high. So the use of low molecular weight heparin is recommended for above patients.

Keywords

References

1- Webb LX, Rush PT, Fuller SB, Meredith JW. Greenfield filters prophylaxis of pulmonary embolism in patients
undergoing surgery for acetabular fracture. J Orthop Trauma 1992; 6:139-45.
2-Anand S, Buch K. Post-discharge symptomatic thromboembolic events in hip fracture patients. Ann R Coll Surg Engl
2007 Jul; 89(5):517-20.
3-Tomotsuka N, Toda N, Shoji E. Acute pulmonary thromboembolism after multiple injuries, despite performing
anticoagulant therapy. Masui 2008 Feb; 57(2):174-7.
4- Galanaud JP, Khau Van Kien A, Boubakri C, Böge G, Laroche JP, Quéré I Calf vein thrombosis: to treat or not to
treat? J Mal Vasc 2007 Sep; 32(4-5):225-8.
5- Dhillon KS, Askander A, Doraismay S. Postoperative deep-vein thrombosis in Asian patients is not a rarity: a
prospective study of 88 patients with no prophylaxis. J Bone Joint Surg Br 1996; 78:427-30.
6- Lee HM, Suk KS, Moon SH, Kim DJ, Wang JM, Kim NH. Deep vein thrombosis after major spinal surgery:
incidence in an East Asian population. Spine 2000; 25:1827-30.
7-Chan YK, Chiu KY, Cheng SW, Ho P. The incidence of deep vein thrombosis in elderly Chinese suffering hip
fracture is low without prophylaxis: a prospective study using serial duplex ultrasound .Orthop Surg (Hong Kong). 2004
Dec; 12(2):178-83.
8-J P Stannard, A K Singhania, R R Lopez-Ben, E R Anderson,Farris RC,Volgas DA,Alonso JE. Deep-vein thrombosis
in high-energy skeletal trauma despite thromboprophylaxis. J Bone Joint Surge (British volume): 2005 Jul; 83-A
(7): 965-969.
9- Eriksson Bl, Lassen MR. Duration of prophylaxis against venous thromboembolism with fondaparinux after hip fracture
surgery: a multicenter, randomized, placebo-controlled, double-blind study. Arch Intern Med 2003; 163:1337-42.
10- Cronan JJ, Froehlich JA, Dorfman CS. Image-directed Doppler ultrasound: a screening technique for patients at
high risk to develop deep vein thrombosis. J Clin Ultrasound 1991; 19:133-8.
11- Roche-Nagle GM, Barry MC, Ryan R, Brophy DP. Considerations in the diagnosis and therapy for deep vein
thrombosis. Am J Emerg Med 2007 Sep; 25(7):860.e1-4
12 - Stannard JP, Riley RS, McClenney MD, Lopez-Ben RR,Volgas DA, Alonso JE. Mechanical prophylaxis against
deep-vein thrombosis after pelvic and acetabular fractures. J Bone Joint Surg [Am] 2001; 83-A: 1047-51.
13- Rubel IF, Potter H, Barie P, Kloen P, Helfet DL. Magnetic resonance venography to evaluate deep venous
thrombosis in patients with pelvic and acetabular trauma. J Trauma 2001:51; 22.
14- Kew J, Lee YL, Davey IC, Ho SY, Fung KC, Metreweli C. Deep vein thrombosis in elderly Hong Kong Chinese
with hip fractures detected with compression ultrasound and Doppler imaging: incidence and effect of low molecular
weight heparin. Arch Orthop Trauma Surg 1999; 119:156-8.
15-Velmajos GC,Kern J,Chan LS,Oder D,Murray JA, Shekelle P. Prevention of venous thromboernbolism after injury:
an evidence-based report: part I: analysis of risk factors and evaluation of the role of vena caval filters. J Trauma 2000;
9:132-8.
16- Russell GV Jr, Nork SE, Chip Routt ML Jr. Perioperative complications associated with operative treatment of
acetabular fractures. J Trauma 2001; 1:1098-103.
17- Aywak AA, Masesa JV. Comparison of sonography with venography in the diagnosis of deep venous thrombosis.
East Afr Med J 2007 Jul; 84(7):304-11
18- Rogers FB. Venous thromboernbolism in trauma patients: a review. Surgery 2001; 130:1-12.
19- Delia Valle CJ, Steiger DJ, DiCesare PE. Duplex ultrasonography in patients suspected of postoperative pulmonary
embolism following total joint arthroplasty. Am J Orthop 2003; 2:386-8.
20- Spritzer CE, Arata MA, Freed KS. Isolated pelvic deep venous thrombosis: relative frequency as detected with MR
imaging. Radiol 2001; 19:521-5.
21-Y K Chan, K Y Chiu, S W K Cheng, P Ho .The incidence of deep vein thrombosis in elderly Chinese suffering hip
fracture is low without prophylaxis: A prospective study using serial duplex ultrasound. J Orthoped Surge. Dec 2004;
(12): 178-84.
medical journal of mashhad university of medical sciences
Volume 51, Issue 1 - Serial Number 1
March and April 2007
Pages 25-28

Files

Share

How to cite

Statistics