Clinical characteristics and risk factors of proximal deep venous thrombosis in patients with fractures / 中华创伤杂志

ABSTRACT

Objective To investigate the clinical characteristics and risk factors of perioperative deep venous thrombosis (DVT) in fracture patients.Methods A retrospective case control study was conducted to analyze the clinical data of 147 patients with DVT diagnosed by color Doppler ultrasound or lower extremity deep venography from July 2015 to November 2017 in Honghui Hospital Affiliated to Xi'an Jiaotong University College of Medicine.The patients were divided into proximal thrombosis group (including the popliteal vein) and distal thrombosis group according to the involvement site with the popliteal vein as reference.The proximal thrombosis group (56 patients) included 31 males and 25 females,aged 38-89 years,with an average age of 67.8 years.There were three patients with pelvic and acetabular fractures,39 with hip fractures,10 with femoral shaft fractures,three with periarticular fractures,and one with tibia and fibula fracture.According to the site of involvement,four patients had proximal vein thrombosis,and the other 52 patients had proximal combined with distal thrombosis.There were 44 patients with left thrombosis and 12 with right thrombosis.Thrombosis at femoral vein and above was found in 20 patients (7 with external iliac vein thrombosis),and thrombosis at popliteal vein was found in 36 patients.The distal thrombosis group (91 patients) consisted of 51 males and 40 females,aged 21-92 years,with an average of 63.6 years.There were 12 patients with pelvic and acetabular fractures,39 with hip fractures,four with femoral shaft fractures,16 with fractures surrounding knee joint,12 with tibia and fibula fractures,and eight with ankle joint fractures.There were 43 patients with left thrombosis and 48 with right thrombosis.The gender,age,fracture location,time from injury to operation,operation time,blood transfusion rate,thrombus side,D-dimer level before and after operation,and internal medical diseases were compared between the two groups.The risk factors with statistical significance were screened for multivariate Logistic regression analysis.Results In proximal thrombosis group,70％ (39/56) had hip fracture and 18％ (10/56) had femoral shaft fracture,while 43％ (39/91) had hip fracture and 4％ (4/91) had femoral shaft fracture in distal thrombosis group (P＜0.05).In the proximal thrombosis group,79％ (44/56) had thrombosis in the left lower extremity,which was much higher than that in the distal thrombosis group 47％ (43/91) (P ＜ 0.05).In proximal thrombosis group,77％ (43/56) received blood transfusion,which was higher than 39％ (35/91) in distal thrombosis group (P ＜0.05).D-dimer levels in proximal thrombosis group before and after operation [(8.5 ± 8.1) mg/L,(12.8 ± 9.7) mg/L],were higher than those in distal thrombosis group [(4.6 ± 3.8) mg/L,(7.2 ± 7.5) mg/L] (P ＜ 0.05).There were no significant differences in gender,age,time from injury to operation,operation time and internal medical complications between the two groups (P ＞0.05).Logistic regression analysis showed that hip fracture and femoral shaft fracture,left lower limb,blood transfusion,high D-dimer level before and after operation were risk factors for proximal thrombosis.Conclusions Proximal venous thrombosis is often combined with distal venous thrombosis.Hip fracture,femoral shaft fracture,left lower limb,blood transfusion,preoperative and postoperative high D-dimer levels have significant effects on proximal thrombosis.