ABSTRACT
BACKGROUND:The risk of lower extremity deep venous thrombosis was high in patients with bone metastases. Major surgery is a major risk factor for thrombosis. There was no standard prophylactic regimen available. OBJECTIVE:To investigate the efficacy and safety of low molecular weight heparins versus rivaroxaban in the postoperative prevention of lower extremity deep venous thrombosis in patients with bone metastases. METHODS:From January 2010 to December 2013, a total of 73 patients with bone metastasis in spine, pelvis and lower extremities, who underwent open surgery in the Department of Musculoskeletal Tumor, Third Hospital, Hebei Medical University, China, were retrospectively analyzed. The patients were divided into low molecular weight heparins group (n=41) and rivaroxaban group (n=32) according to the prophylactic drugs after surgery. RESULTS AND CONCLUSION:Nine cases (22%) in the low molecular weight heparins group were found lower extremity deep venous thrombosis, and six cases (19%) in the rivaroxaban group suffered from lower extremity deep venous thrombosis, showing no significant differences (χ2=0.11, P=0.74). The incidences of bleeding events in both groups were respectively 7.32%and 6.25%, showing no significant differences (correctionχ2=0.083, P>0.05). There were no significant differences regarding the levels of platelet, activated partial thromboplastin time and prothrombin time between both groups preoperatively or postoperatively (P>0.05). Therefore, the efficacy and safety of low molecular weight heparins and rivaroxaban in the postoperative prevention of lower extremity deep venous thrombosis were similar. Both could effectively reduce the incidence of deep venous thrombosis, with a relative low risk of bleeding.
ABSTRACT
<p><b>OBJECTIVE</b>To analyze the risk factors for deep vein thrombosis (DVT) of the lower extremity in patients with bone metastases.</p><p><b>METHODS</b>Ninety patients with bone metastases were admitted to our hospital From January 2010 to December 2011, and their clinical data were retrospectively analyzed. There were 57 males and 33 females with a mean age of 61 years (range, 27 to 78 years). On admission, all cases were detected by color Doppler ultrasonography for DVT of bilateral lower extremities. Univariate and multivariate analyses were performed to determine the probable risk factors including gender, age, body weight, tumor location, bed confinement and etc.</p><p><b>RESULTS</b>Among the 90 patients, DVT was found in 24 patients on admission and the DVT incidence was 26.7% (24/90). The univariate analysis showed that bed confinement, multiple metastasis, pathological fracture, primary lesion detected, blood group, fibrinogen and hematocrit were significantly related to the incidence of DVT (P < 0.05). The logistic multivariate regression analysis showed that bed confinement, pathological fracture and fibrinogen were independent risk factors for the incidence of DVT.</p><p><b>CONCLUSIONS</b>Bed confinement, pathological fracture and fibrinogen are independent risk factors for the incidence of DVT for patients with bone metastases. Patients with bed confinement >3 days, pathological fracture or fibrinogen >4 g/L should be routinely screened for lower extremity DVT on admission. Once identified, the DVT patients should be treated as early as possible.</p>