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Kim Y, Jeong M, Park MW, Shin HI, Lee BC, Kim DH. Incidence and risk factors of deep vein thrombosis and pulmonary thromboembolism after spinal cord disease at a rehabilitation unit: a retrospective study. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:S56-S64. [PMID: 37726959 DOI: 10.12701/jyms.2023.00689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/03/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are major complications of spinal cord disease. However, studies of their incidence in Korean patients are limited. Thus, this study investigated the incidence and risk factors of DVT and PTE in Korean patients with spinal cord disease. METHODS We retrospectively analyzed the medical records of 271 patients with spinal cord disease who were admitted to a rehabilitation unit within 3 months of disease onset at a tertiary hospital. The presence of DVT and PTE was mainly determined using Doppler ultrasonography and chest embolism computed tomography. Risk factor analysis included variables such as sex, age, obesity, completeness of motor paralysis, neurological level of injury, cause of injury, lower extremity fracture, active cancer, and functional ambulation category (FAC) score. RESULTS The incidences of DVT and PTE in the patients with spinal cord disease were both 6.3%. Risk factor analysis revealed that age of ≥65 years (p=0.031) and FAC score of ≤1 (p=0.023) were significantly associated with DVT development. Traumatic cause of injury (p=0.028) and DVT (p<0.001) were significant risk factors of PTE. CONCLUSION Patients with spinal cord disease developed DVT and PTE within 3 months of disease onset with incidence rates of 6.3% and 6.3%, respectively. Age of ≥65 years and an FAC of score ≤1 were risk factors for DVT. Traumatic cause of injury and DVT were risk factors for PTE. However, given the inconsistent results of previous studies, the risk factors for DVT and PTE remain inconclusive. Therefore, early screening for DVT and PTE should be performed in patients with acute-to-subacute spinal cord disease regardless of the presence or absence of these risk factors.
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Affiliation(s)
- Yoonhee Kim
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Minjae Jeong
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myung Woo Park
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Iee Shin
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byung Chan Lee
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Du Hwan Kim
- Department of Physical and Rehabilitation Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Peng J, Feng B, Ren W, Jiang S, Wu C, Hu Z, Xu W. Incidence and risk factors of isolated calf muscular venous thrombosis after tibial plateau fractures surgery. BMC Musculoskelet Disord 2023; 24:625. [PMID: 37532980 PMCID: PMC10394767 DOI: 10.1186/s12891-023-06764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 07/28/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The risks associated with deep vein thrombosis (DVT) have gained significant recognition over time. A prevalent form of distal DVT is isolated calf muscular venous thrombosis (ICMVT). Despite its common clinical occurrence, data on ICMVT subsequent to tibial plateau fracture (TPF) surgery are scarce. This study aimed to examine the epidemiological characteristics and associated risk factors (RFs) of ICMVT following TPF surgery. METHODS For this retrospective analysis, we included patients from our hospital, who underwent TPF surgery between March 2017 and March 2021. Patients' electronic medical records were reviewed, including admission details, fracture classification, surgical procedures, and laboratory biomarkers. The HSS (The American Hospital for Special Surgery) and Rasmussen scores were employed to evaluate the clinical effect. A Color Duplex Flow Imager (CDFI) was regularly used to detect pre- and postoperative venous thrombosis in the lower limbs. Finally, uni- and multivariate logistic regression analyses were used to identify independent RFs associated with ICMVT. RESULTS Overall, 481 participants were recruited for analysis. Postoperative ICMVT occurred in 47 patients. All ICMVTs occurred on the affected side. Four of the 47 ICMVT patients exhibited sudden postoperative swelling in the affected limb. The HSS and Rasmussen scores in the non-ICMVT cohort (87.6 ± 8.2, 16.0 ± 1.7) were markedly different from the ICMVT cohort (84.8 ± 8.2, 15.5 ± 1.6) (p = 0.014, p = 0.031). This study finally identified five postoperative ICMVT-related RFs, which were age (> 55 years old) (OR 3.06; 95% CI 1.47-6.37; p = 0.003), gender (female) (OR 2.67; 95% CI 1.37-5.22; p = 0.004), surgical duration (> 114 min) (OR 3.14; 95% CI 1.44-6.85; p = 0.004), elevated white blood cell content (OR 2.85; 95% CI 1.47-5.51; p = 0.002), and hyponatremia (OR 2.31; 95% CI 1.04-5.12; p = 0.040). CONCLUSION The epidemiological findings of this study may help predict ICMVT risk after surgery thus facilitating the development of individualized clinical assessments and targeted prevention programs.
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Affiliation(s)
- Jian Peng
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No.1055, SanXiang Road, Gusu District, Suzhou, Jiangsu Province, 215004, PR China
| | - Bin Feng
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No.1055, SanXiang Road, Gusu District, Suzhou, Jiangsu Province, 215004, PR China
| | - Weizhi Ren
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No.1055, SanXiang Road, Gusu District, Suzhou, Jiangsu Province, 215004, PR China
| | - Shijie Jiang
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No.1055, SanXiang Road, Gusu District, Suzhou, Jiangsu Province, 215004, PR China
| | - Chenying Wu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, No.1055, SanXiang Road, Gusu District, Suzhou, 215004, China
| | - Zhenghui Hu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No.1055, SanXiang Road, Gusu District, Suzhou, Jiangsu Province, 215004, PR China
| | - Wei Xu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, No.1055, SanXiang Road, Gusu District, Suzhou, Jiangsu Province, 215004, PR China.
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Wang C, Yu X, Wang T, Ding M, Ran L. D-dimer/fibrinogen ratio for the prediction of deep venous thrombosis after traumatic spinal cord injury. Spinal Cord 2023; 61:447-452. [PMID: 37380758 DOI: 10.1038/s41393-023-00905-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 05/22/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To evaluate the predictive value of D-dimer/fibrinogen (D/F) ratio for deep vein thrombosis (DVT) in patients with traumatic spinal cord injury (SCI). SETTING Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University. METHODS SCI patients within 24 h of trauma were consecutively enrolled. DVT was diagnosed by DUS examination during hospitalization. Multivariable logistic regression analysis was performed to determine the relationship between D/F ratio and DVT. Stratified logistic regression analysis was performed to identify effect modifiers. The receiver operating characteristic (ROC) curve was conducted to assess the predictive value of D/F ratio. RESULTS A total of 284 patients with SCI were included, of whom 106 (37.3%) developed DVT. D/F ratio was positively correlated with DVT (OR 1.17, 95% confidence interval [CI] 1.04-1.31, p = 0.009). Patients in the upper D/F ratio tertile (3.15-18.27) had a higher risk of DVT than patients in the lower tertile (0.08-0.97) after adjustment for potential confounders (OR 6.01, 95% CI 2.24-16.15, p < 0.001). The risk of DVT increased stepwise across D/F ratio tertiles (p for trend = 0.003). The area under the ROC curve (AUC) was 0.758 (95% CI 0.704-0.806). There was a significant interaction between D/F ratio and neurological level of injury (p for interaction = 0.003) and the association between D/F ratio and DVT remained significant only in patients with cervical injury. CONCLUSIONS A higher D/F ratio was independently associated with a higher risk of DVT in a dose-dependent manner in patients with cervical SCI.
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Affiliation(s)
- Changyi Wang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Xi Yu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tiantian Wang
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingfu Ding
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Liyu Ran
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Mi YH, Xu MY. Trauma-induced pulmonary thromboembolism: What's update? Chin J Traumatol 2022; 25:67-76. [PMID: 34404569 PMCID: PMC9039469 DOI: 10.1016/j.cjtee.2021.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 02/04/2023] Open
Abstract
Trauma-induced pulmonary thromboembolism is the second leading cause of death in severe trauma patients. Primary fibrinolytic hyperactivity combined with hemorrhage and consequential hypercoagulability in severe trauma patients create a huge challenge for clinicians. It is crucial to ensure a safe anticoagulant therapy for trauma patients, but a series of clinical issues need to be answered first, for example, what are the risk factors for traumatic venous thromboembolism? How to assess and determine the status of coagulation dysfunction of patients? When is the optimal timing to initiate pharmacologic prophylaxis for venous thromboembolism? What types of prophylactic agents should be used? How to manage the anticoagulation-related hemorrhage and to determine the optimal timing of restarting chemoprophylaxis? The present review attempts to answer the above questions.
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Alostaz H, Cai L. Biomarkers from Secondary Complications in Spinal Cord Injury. CURRENT PHARMACOLOGY REPORTS 2022; 8:20-30. [PMID: 36147780 PMCID: PMC9491488 DOI: 10.1007/s40495-021-00268-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
PURPOSE OF REVIEW In the USA, spinal cord injury (SCI) occurs in 40 people per million every year due to events such as car accidents, falls, violence, or sports injury. Secondary complications that arise from SCI are life-threatening and should be treated as early as possible. In some cases, it is not completely obvious what complication a patient may have until it is too late. Therefore, biomarkers are required to assess the levels of secondary complications after SCI. As there are several complications that pose different warning signs, different biomarkers may be beneficial in early detection, maintenance, and long-term care for patients with SCI. RECENT FINDINGS Numerous studies have been conducted on biomarkers in various SCI and its related complications, such as neuropathic pain and deep vein thrombosis. In recent years, research has expanded with biomarkers discovered by cellular and molecular, genome-wide transcriptomic analysis, bioinformatics, and clinical studies. Biomarkers have allowed early prediction of the severity of secondary complications due to SCI. SUMMARY In this review, we summarize recent studies on the common biomarkers for the secondary complications related to SCI. We highlight the reliable biomarkers that have been tested, e.g., sclerostin, NGF, D-dimer, oncostatin M (OSM), microbiota, and C-reactive protein, which are valuable and with clinical importance. This review also emphasizes continuing research in biomarkers as they can provide valuable cellular and molecular insight into secondary complications after SCI.
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Affiliation(s)
- Hani Alostaz
- Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, NJ 08854, USA
| | - Li Cai
- Department of Biomedical Engineering, Rutgers University, 599 Taylor Road, Piscataway, NJ 08854, USA
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Ichikawa N, Kumagai G, Wada K, Kudo H, Asari T, Xizhe L, Ishibashi Y. High incidence of venous thromboembolism after acute cervical spinal cord injury in patients with ossification of the posterior longitudinal ligament. J Spinal Cord Med 2022; 45:100-105. [PMID: 32401638 PMCID: PMC8890512 DOI: 10.1080/10790268.2020.1758385] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective: To determine the incidence of venous thromboembolism (VTE) in patients with acute cervical spinal cord injury (SCI) and ossification of the posterior longitudinal ligament (OPLL).Design: Prospective cohort study.Setting: A department of a university hospital in Japan.Participants: This study included 57 patients (OPLL, n = 10; non-OPLL, n = 47) treated for acute cervical SCI between January 2011 and April 2017. Patients were classified according to motor complete paralysis (MC), motor incomplete paralysis (MIC), or normal motor function, based on American Spinal Injury Association (ASIA) Impairment Scale results.Interventions: N/A.Outcome Measures: All patients were screened for VTE by D-dimer monitoring, and some underwent ultrasonography. If ultrasonography indicated deep venous thrombosis (DVT) or if the D-dimers increased to ≥10 µg/mL, patients underwent contrast venography to detect VTE, including DVT or pulmonary embolism. We compared blood coagulability and VTE incidence in the OPLL and non-OPLL groups.Results: VTE occurred in 11 (19.3%) of 57 patients. The incidence of VTE was higher in the OPLL group than in the non-OPLL group (50% vs. 12.8%; P = 0.017) and higher in the MC group (57.1%) than in the MIC (8.3%; P = 0.002) or normal group (5.3%; P = 0.002). In the MC group, VTE occurred in 50% of OPLL patients and in 62.5% of non-OPLL patients (P = 0.529). In the MIC group, VTE occurred in 50% of OPLL patients and in none of the non-OPLL patients (P = 0.022).Conclusions: Patients with OPLL tended to develop VTE after SCI with motor complete and incomplete paralysis.
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Affiliation(s)
- Nana Ichikawa
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan,Correspondence to: Gentaro Kumagai, Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori036-8562, Japan; Ph: +81-172-39-5083;
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Hitoshi Kudo
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Liu Xizhe
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Lv B, Wang H, Li W, Han G, Liu X, Zhang C, Zhang Z. Admission Prevalence and Risk Factors of Deep Vein Thrombosis in Patients with Spinal Cord Injury Complicated with Cervical Fractures. Clin Appl Thromb Hemost 2022; 28:10760296221108969. [PMID: 35763449 PMCID: PMC9247371 DOI: 10.1177/10760296221108969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to investigate the prevalence of deep vein
thrombosis (DVT) and to clarify the risk factors of DVT in patients with acute
spinal cord injury (SCI) complicated with cervical fractures at admission. From
January 2018 to December 2021, a total of 175 patients with acute SCI
complicated with cervical fractures in our hospital were retrospectively
analyzed. Duplex ultrasound was used to diagnose the DVT. All patients' medical
record data, including demographic variables, medical history, and laboratory
results, were collected. The patients were divided into DVT group and non-DVT
group according to ultrasound results. The prevalence of DVT was determined and
risk factors of DVT were identified. Receiver operating characteristic (ROC)
curve analysis was used to evaluate the diagnostic value of different factors.
The prevalence of DVT at admission was 21.71%(38/175), including one (2.63%)
with central DVT, thirty-two (84.21%) with peripheral DVT and five (13.16%) with
mixed DVT. The multivariate analysis revealed that decreased lower extremity
muscle strength, time from injury to admission, and D-dimer were risk factors
for DVT at admission. The diagnostic value of D-dimer was the highest among
these risk factors. In conclusion, in patients with acute SCI complicated with
cervical fractures, the risk of DVT at admission is very high. Decreased lower
extremity muscle strength, time from injury to admission, and D-dimer are risk
factors for DVT. Moreover, D-dimer has the highest diagnostic value among these
risk factors.
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Affiliation(s)
- Bing Lv
- Department of Medical Ultrasonics, 592469Baoding No.1 Central Hospital, Baoding, PR China
| | - Haiying Wang
- Department of Orthopaedic Surgery, Baoding No.1 Central Hospital, Baoding, PR China
| | - Weifeng Li
- Department of Orthopaedic Surgery, Baoding No.1 Central Hospital, Baoding, PR China
| | - Gefeng Han
- Department of Orthopaedic Surgery, Baoding No.1 Central Hospital, Baoding, PR China
| | - Xiangdong Liu
- Department of Orthopaedic Surgery, Baoding No.1 Central Hospital, Baoding, PR China
| | - Cheng Zhang
- Department of Orthopaedic Surgery, Baoding No.1 Central Hospital, Baoding, PR China
| | - Zipeng Zhang
- Department of Orthopaedic Surgery, Baoding No.1 Central Hospital, Baoding, PR China
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Mackiewicz-Milewska M, Kroszczynski A, Cisowska-Adamiak M, Pyskir J, Rosc D, Hagner W. Hemostatic parameters in patients with spinal cord injury in subacute and chronic phase of the rehabilitation. J Spinal Cord Med 2021; 44:782-788. [PMID: 32011973 PMCID: PMC8477962 DOI: 10.1080/10790268.2019.1708600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective: The goal of this study was to measure hemostatic markers after SCI.Design: Assesing changes in coagulation and fibrynilitic system in SCI patients in different time post injury to Cross-sectional study.Setting: Rehabilitation Department of the Bydgoszcz University Hospital, Poland from 2011 to 2017.Participants: SCI patient during acute and chronic rehabilitation (N = 88).Outcome Measures: Assesing following parameters: platelet counts and levels of D-dimer, antithrombin III (ATIII), tissue factor (TF), tissue factor pathway inhibitor (TFPI) and the inflammatory marker, C-reactive protein (CRP).Interventions: Eighty-eight SCI patients were divided into three groups based on the time elapsed from injury: group I (three weeks to three months), group II (three to twelve months) and group III (more than twelve months). All patients underwent ultrasonography (US) to detect acute or chronic recanalized deep vein thrombosis (DVT). Platelet counts and levels of D-dimer, ATIII, TF, TFPI and CRP were assessed. TF and TFPI levels were measured in the control group of forty healthy individuals without SCI, the rest of the parameters were compared to laboratory norms.Results: D-dimer levels were significantly higher in group I compared to group II (P = .0002) and group III (P < .001). Group II had higher D-dimer levels than group III (P = .032). TFPI levels were higher in group II compared with group III (P = .0041) and control group (P = .000033). TF was significantly higher in all the SCI groups compared with the control group (P < .001).Conclusions: D-dimer and TF levels were still elevated twelve months after SCI. TF levels were also elevated over 12 months after inury. The results may indicate that sub-acute and even chronic SCI patients have disturbed coagulation and fibrynolitic system.
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Affiliation(s)
- Magdalena Mackiewicz-Milewska
- Department of Rehabilitation Collegium Medicum in Bydgoszcz, Faculty of Health Science, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland,Correspondence to: Magdalena Mackiewicz-Milewska, University Hospital no.1 in Bydgoszcz, Skłodowskiej-Curie 9 Street, Bydgoszcz85–091, Poland; Ph: +48 52 5854674.
| | | | - Małgorzata Cisowska-Adamiak
- Department of Rehabilitation Collegium Medicum in Bydgoszcz, Faculty of Health Science, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Jerzy Pyskir
- Department of Biophysics Collegium Medicum in Bydgoszcz, Faculty of Pharmacy, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Danuta Rosc
- Department of Pathophysiology Collegium Medicum in Bydgoszcz, Faculty of Pharmacy Nicolaus, Copernicus University, Bydgoszcz, Poland
| | - Wojciech Hagner
- Department of Rehabilitation Collegium Medicum in Bydgoszcz, Faculty of Health Science, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Usefulness of D-dimer and Ultrasonography Screening for Detecting Deep Vein Thrombosis in Patients with Spinal Cord Injury Undergoing Rehabilitation. J Clin Med 2021; 10:jcm10040689. [PMID: 33578938 PMCID: PMC7916660 DOI: 10.3390/jcm10040689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/26/2022] Open
Abstract
Patients with spinal cord injury (SCI) are at an increased risk of deep vein thrombosis (DVT). This study aims at assessing usefulness of D-dimer and compressive Doppler ultrasonography (CDUS) for detecting DVT in patients undergoing rehabilitation at various time-points post-SCI. One-hundred forty-five patients were divided into three groups based on time elapsed since SCI: I (≥3 weeks to 3 months), II (≥3 to 6 months), and III (≥6 months). On admission, D-dimer plasma level measurement and CDUS of the lower limbs venous system were performed. DVT was diagnosed using CDUS in 15 patients (10.3% of entire group), more frequently in group I (22.2% of group) and II (11.7%) compared to group III (1.5%). Most DVT patients received thromboprophylaxis (80%) and were asymptomatic or mildly symptomatic (60%). Median D-dimer was elevated in patients with DVT from all groups, and also patients without DVT from groups I and II, but not group III. D-dimers were higher in patients with DVT than without DVT in the entire group (p = 0.001) and group I (p = 0.02), but not in groups II and III. The risk of DVT in SCI patients undergoing rehabilitation and thromboprophylaxis including asymptomatic or mildly symptomatic cases, is high within 6 months post-injury, and especially within 3 months. Measurement of D-dimer level should be complemented by routine CDUS for detecting DVT within 6 months post-SCI. Over 6 months, the usefulness of D-dimer screening alone is better for DVT detection.
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Zhu Y, Chen W, Li J, Zhao K, Zhang J, Meng H, Zhang Y, Zhang Q. Incidence and locations of preoperative deep venous thrombosis (DVT) of lower extremity following tibial plateau fractures: a prospective cohort study. J Orthop Surg Res 2021; 16:113. [PMID: 33546695 PMCID: PMC7863261 DOI: 10.1186/s13018-021-02259-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
Background There is still lack of data on deep vein thrombosis (DVT) following bone trauma. This study aimed to determine the epidemiologic characteristics of deep venous thrombosis (DVT) of lower extremities following tibial plateau fractures. Methods Retrospective analysis of prospectively collected data on patients presenting with tibial plateau fractures between October 2014 and December 2018 was conducted. Duplex ultrasonography (DUS) was routinely used to screen for preoperative DVT of bilateral lower extremities. Data on demographics, comorbidities, injury-related data, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT. Results A total of 1179 patients were included, among whom 192 (16.3%) had a preoperative DVT, with incidence rate of 1.0% for proximal and 15.3% for distal DVT. The average interval between fracture occurrence and diagnosis of DVT was 3.5 days (median, 2 days), ranging from 0 to 19 days. DVT involved the injured extremity in 166 (86.4%) patients, both the injured and uninjured extremities in 14 patients (7.3%) and only the uninjured extremity in 12 patients (6.3%). Six risk factors were identified to be associated with DVT, including gender (male vs female), hypertension, open fracture, alkaline phosphatase > 100 u/L, sodium concentration < 135 mmol/L, and D-dimer > 0.5 mg/L. Conclusion These epidemiologic data are conducive to the individualized assessment, risk stratification, and development of targeted prevention programs.
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Affiliation(s)
- Yanbin Zhu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Junyong Li
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Junzhe Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Hongyu Meng
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Chinese Academy of Engineering, Beijing, 100088, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Shijiazhuang, Hebei, 050051, P.R. China.
| | - Qi Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
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11
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Li J, Zhu Y, Chen W, Zhao K, Zhang J, Meng H, Jin Z, Ye D, Zhang Y. Incidence and locations of deep venous thrombosis of the lower extremity following surgeries of tibial plateau fractures: a prospective cohort study. J Orthop Surg Res 2020; 15:605. [PMID: 33317585 PMCID: PMC7735415 DOI: 10.1186/s13018-020-02136-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/30/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To investigate the incidence of deep venous thrombosis (DVT) of the lower extremities following surgeries of tibial plateau fractures. METHODS Retrospective analysis of the prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was conducted. Duplex ultrasonography (DUS) was used to screen for postoperative DVT of the bilateral lower extremities. Data on demographics, comorbidities, injury, surgery, and laboratory biomarkers at admission were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT. RESULTS Among 987 patients included, 46 (4.7%) had postoperative DVT, with incidence rate of 1.0% for proximal and 3.7% for distal DVT. The average interval between operation and DVT was 8.3 days (median, 5.8 days), ranging from 2 to 42 days. DVT involved the injured extremity in 39 (84.8%) patients, both the injured and uninjured extremity in 2 patients (4.3%) and only the uninjured extremity in 5 patients (10.9%). Five risk factors were identified to be associated with postoperative DVT, including age (≥ 41 vs < 41 years) (OR 3.08; 95% CI 1.43-6.61; p = 0.004), anesthesia (general vs regional) (OR 2.08; 95% CI 1.12-3.85; p = 0.021), hyponatremia (OR 2.21; 95% CI 1.21-4.06; p = 0.010), prolonged surgical time (OR 1.04; 95% CI 1.01-1.07; p = 0.017) and elevated D-dimer level (OR 2.79; 95% CI 1.34-4.83; p = 0.004). CONCLUSION These epidemiologic data may be helpful in individualized assessment, risk stratification, and development of targeted prevention programs.
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Affiliation(s)
- Junyong Li
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,The Second Hospital of Shijiazhuang City, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Junzhe Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Hongyu Meng
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Zhucheng Jin
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Dandan Ye
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China.,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, PR China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, PR China. .,Orthopaedic Institution of Hebei Province, Shijiazhuang, 050051, Hebei, PR China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment, Hebei, 050051, Shijiazhuang, People's Republic of China.
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12
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Weidner N, Müller OJ, Hach-Wunderle V, Schwerdtfeger K, Krauspe R, Pauschert R, Waydhas C, Baumberger M, Göggelmann C, Wittgruber G, Wildburger R, Marcus O. Prevention of thromboembolism in spinal cord injury -S1 guideline. Neurol Res Pract 2020; 2:43. [PMID: 33324943 PMCID: PMC7727164 DOI: 10.1186/s42466-020-00089-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Traumatic and non-traumatic spinal cord injury bears a high risk for thromboembolism in the first few months after injury. So far, there is no consented guideline regarding diagnostic and prophylactic measures to prevent thromboembolic events in spinal cord injury. Based on a Pubmed research of related original papers and review articles, international guidelines and a survey conducted in German-speaking spinal cord injury centers about best practice prophylactic procedures at each site, a consensus process was initiated, which included spinal cord medicine experts and representatives from medical societies involved in the comprehensive care of spinal cord injury patients. The recommendations comply with the German S3 practice guidelines on prevention of venous thromboembolism. Recommendations Specific clinical or instrument-based screening methods are not recommended in asymptomatic SCI patients. Based on the severity of neurological dysfunction (motor completeness, ambulatory function) low dose low molecular weight heparins are recommended to be administered up to 24 weeks after injury. Besides, mechanical methods (compression stockings, intermittent pneumatic compression) can be applied. In chronic SCI patients admitted to the hospital, thromboembolism prophylactic measures need to be based on the reason for admission and the necessity for immobilization. Conclusions Recommendations for thromboembolism diagnostic and prophylactic measures follow best practice in most spinal cord injury centers. More research evidence needs to be generated to administer more individually tailored risk-adapted prophylactic strategies in the future, which may help to further prevent thromboembolic events without causing major side effects. The present article is a translation of the guideline recently published online (https://www.awmf.org/uploads/tx_szleitlinien/179-015l_S1_Thromboembolieprophylaxe-bei-Querschnittlaehmung_2020-09.pdf).
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Affiliation(s)
- Norbert Weidner
- Klinik für Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
| | - Oliver J Müller
- Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Viola Hach-Wunderle
- Klinik für Gefäßchirurgie und Gefäßmedizin, Krankenhaus Nordwest, Frankfurt/M., Germany
| | - Karsten Schwerdtfeger
- Klinik für Neurochirurgie, Universitätsklinikum des Saarlandes, Homburg Saar, Germany
| | - Rüdiger Krauspe
- Klinik und Poliklinik für Orthopädie, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Rolf Pauschert
- Fachabteilung für Orthopädie/Unfallchirurgie, SRH Gesundheitszentrum Bad Wimpfen, Bad Wimpfen, Germany
| | - Christian Waydhas
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | | | - Christoph Göggelmann
- Klinik für Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.,Klinik für Innere Medizin III: Kardiologie, Angiologie und Pneumologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
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13
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Zixuan L, Chen W, Li Y, Wang X, Zhang W, Zhu Y, Zhang F. Incidence of deep venous thrombosis (DVT) of the lower extremity in patients undergoing surgeries for ankle fractures. J Orthop Surg Res 2020; 15:294. [PMID: 32736663 PMCID: PMC7393865 DOI: 10.1186/s13018-020-01809-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 07/22/2020] [Indexed: 12/23/2022] Open
Abstract
Objective To investigate the incidence of postoperative deep venous thrombosis (DVP) in patients undergoing surgeries for ankle fractures and identify the associated risk factors. Methods This was a retrospective study. A total of 1451 patients undergoing surgery of ankle fractures from January 2016 to June 2019 were included. The inpatient medical record system was inquired for data collection, including demographics, comorbidities, injury, and surgery-related data, and laboratory biomarkers. DVT of the lower extremity was diagnosed by routine Doppler examination. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Results Among the 1451 patients, DVT was confirmed in 38 cases, indicating an incidence of 2.6%. DVT involved both the operated and non-operated limbs in 8 patients (21.1%). DVT involved superficial femoral vein in 4 cases (6.6%), deep femoral vein in 2 (3.3%), popliteal vein in 5 (8.2%), posterior tibial vein in 11 (18.0%), and peroneal vein in 39 (63.9%). The median interval between operation and diagnosis of DVT was 7 days. Six risk factors were identified to be independently associated with DVT, including age (10-year increase) (OR, 1.44), preoperative stay (delay of each day) (OR, 1.11), anesthesia (general vs regional) (OR, 3.51), lower hemoglobin level (OR, 2.02), total cholesterol > 5.2 mmol/L (OR, 3.20), and reduced lymphocyte count (OR, 3.16). Conclusion These identified factors, although not easily modifiable, do help counsel patients about the risk of DVT and help individualized assessment of the risk factors and accordingly the risk stratification.
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Affiliation(s)
- Luo Zixuan
- Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yansen Li
- Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Xiaomeng Wang
- Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Weili Zhang
- Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China. .,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, Hebei, People's Republic of China.
| | - Fengqi Zhang
- Department of Foot and Ankle Surgery, The 3rd Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
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14
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Correlation Between D-Dimer Level and Deep Venous Thrombosis in Patients With Acute Spinal Cord Injuries. Am J Phys Med Rehabil 2020; 99:613-616. [PMID: 31996567 PMCID: PMC7292501 DOI: 10.1097/phm.0000000000001383] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental digital content is available in the text. Objective Venous thromboembolism is a serious life-threatening complication of S SCI. Measurement of D-dimer levels is used as a screening test for deep vein thrombosis. However, trauma, surgery, and motor weakness are known as factors that affect D-dimer levels. Thus, the aim of this study was to examine the correlation between D-dimer levels and deep vein thrombosis in relation to the comorbidities in acute spinal cord injury. Design A retrospective observational study was conducted at a hospital’s rehabilitation department. Forty-five patients without pharmacologic thromboembolic thromboprophylaxis 5−90 days after the onset of injury were enrolled. Results Fourteen patients (31%) were diagnosed with deep vein thrombosis using duplex ultrasonography. The mean ± SD D-dimer levels were 2.15 ± 2.74 and 6.98 ± 7.46 μg/ml in the deep vein thrombosis–negative and deep vein thrombosis–positive groups, respectively. The lower limb motor index scores significantly correlated with D-dimer levels regardless of the time between the onset of spinal cord injury and D-dimer testing. Patients with trauma had significantly increased D-dimer levels compared with patients without trauma. Conclusion Although D-dimer levels have limitations with regard to the positive prediction of acute spinal cord injury, it is a useful screening parameter for deep vein thrombosis. Trauma and lower limb motor weakness should be considered when analyzing D-dimer levels.
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15
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Preoperative incidence and locations of deep venous thrombosis (DVT) of lower extremity following ankle fractures. Sci Rep 2020; 10:10266. [PMID: 32581237 PMCID: PMC7314767 DOI: 10.1038/s41598-020-67365-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/04/2020] [Indexed: 11/18/2022] Open
Abstract
This retrospective study aimed to investigate the preoperative incidence and locations of deep venous thrombosis (DVT) in patients undergoing surgeries for ankle fractures and identify the associated risk factors. From January 2016 to June 2019, 1,532 patients undergoing surgery of ankle fractures were included. Their inpatient medical records were inquired for data collection, including demographics, comorbidities, injury-related data and preoperative laboratory biomarkers. DVT of bilateral lower extremities was diagnosed by routine preoperative Doppler examination. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors. Totally, 98 patients had a preoperative DVT, indicating an incidence rate of 6.4%. A total of 164 clots for 6 veins were found, representing an average of 1.7 for each patient. The detailed DVTs involving veins were as follows: 2 in femoral common vein, 7 in superficial femoral vein, 2 in deep femoral vein, 16 in popliteal vein, 49 in posterior tibial vein, and 88 in peroneal vein. In the multivariate model, 5 risk factors were identified to be associated with DVT, including age (10-year increase), gender, lower ALB level, reduced LYM count and elevated D-dimer level. There was a tendency for diabetes mellitus to increase the risk of DVT, although there was no statistical significance (p = 0.063). These epidemiologic data on DVT may help counsel patients about the risk of DVT, individualized risk assessment and accordingly the risk stratification.
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16
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Kumagai G, Wada K, Kudo H, Asari T, Ichikawa N, Ishibashi Y. D-dimer monitoring combined with ultrasonography improves screening for asymptomatic venous thromboembolism in acute spinal cord injury. J Spinal Cord Med 2018; 43:353-357. [PMID: 30199352 PMCID: PMC7241454 DOI: 10.1080/10790268.2018.1518765] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective: We compared screening methods for asymptomatic venous thromboembolism (VTE) in patients with acute spine and spinal cord injuries (SCI). Patients were screened by D-dimer monitoring alone (DS group) or by D-dimer monitoring combined with ultrasonography (DUS group).Design: Prospective cohort study.Setting: One department of a university hospital in Japan.Participants: 114 patients treated for acute SCI between 2011 and 2017.Interventions: N/A.Outcome Measures: D-dimers were measured upon admission and 1, 3, 5, 7, and 14 days thereafter. DUS-group patients also underwent an ultrasound 7 days after admission. If ultrasonography indicated deep venous thrombosis (DVT), or if D-dimer levels increased to ≥ 10 µg/mL, the patient was assessed for VTE, including DVT or pulmonary embolism (PE), by contrast venography. We analyzed the incidence of VTE detected in the DS and DUS groups.Results: In the DS group, D-dimers were elevated (≥ 10 µg/mL) in 15 of 70 patients (21.4%), and 9 of the 15 had asymptomatic VTE (12.9%, DVT 11.4%, PE 5.7%). In the DUS group, one patient developed VTE on day 4, and D-dimers were elevated in 13 of 43 patients (30.2%), ultrasonography indicated DVT in 12 patients (27.9%), and asymptomatic VTE was diagnosed in 12 patients (27.9%, DVT 27.9%, PE 4.7%). The DUS group had a higher incidence of DVT (P = 0.002) and VTE (P = 0.042) than the DS group.Conclusions: Combined D-dimer and ultrasound screening in patients with acute SCI improved the detection of VTE, including PE, compared with D-dimer screening alone.
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Affiliation(s)
- Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan,Correspondence to: Gentaro Kumagai, Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan; Ph: +81-172-39-5083.
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Hitoshi Kudo
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Nana Ichikawa
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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17
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Yumoto T, Naito H, Yamakawa Y, Iida A, Tsukahara K, Nakao A. Venous thromboembolism in major trauma patients: a single-center retrospective cohort study of the epidemiology and utility of D-dimer for screening. Acute Med Surg 2017; 4:394-400. [PMID: 29123899 PMCID: PMC5649298 DOI: 10.1002/ams2.290] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 05/05/2017] [Indexed: 11/11/2022] Open
Abstract
Aim Venous thromboembolism (VTE) can be a life‐threatening complication after major trauma. The aim of this study was to investigate the epidemiology of VTE and to assess the usefulness of D‐dimer for screening for VTE in major trauma cases among the Japanese population. Methods We examined a single‐center retrospective cohort of severely injured trauma patients who had been admitted to the emergency intensive care unit at Okayama University Hospital (Okayama, Japan) from April 2013 through to March 2016. Venous thromboembolism was confirmed by computed tomography angiography and computed tomography venography, which was determined based on the attending physician monitoring daily D‐dimer levels. Independent risk factors for VTE were determined by multiple logistic regression analysis. D‐dimer levels were evaluated using area under the receiver operating characteristic curve (AUROC) to predict VTE. Results The study cohort consisted of 204 trauma patients (median Injury Severity Score, 20). Of the 204 patients, 65 (32%) developed VTE. The median time from admission to VTE diagnosis was 10 days. In multiple logistic regression analysis, higher Injury Severity Score and the presence of lower extremity fractures were revealed to be a risk factor for VTE. D‐dimer levels at day 10 showed moderate accuracy, of which the AUROC was 0.785 (95% confidence interval, 0.704–0.866; P < 0.001). The cut‐off that maximized the Youden index was 12.45 μg/mL. Conclusions At least one of every three major trauma patients had potential development of VTE at a median of 10 days following admission to the intensive care unit. D‐dimer levels on day 10 can be a useful predictor of VTE.
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Affiliation(s)
- Tetsuya Yumoto
- Advanced Emergency and Critical Care Medical Center Okayama University Hospital Okayama Japan
| | - Hiromichi Naito
- Advanced Emergency and Critical Care Medical Center Okayama University Hospital Okayama Japan
| | - Yasuaki Yamakawa
- Advanced Emergency and Critical Care Medical Center Okayama University Hospital Okayama Japan
| | - Atsuyoshi Iida
- Advanced Emergency and Critical Care Medical Center Okayama University Hospital Okayama Japan
| | - Kohei Tsukahara
- Advanced Emergency and Critical Care Medical Center Okayama University Hospital Okayama Japan
| | - Atsunori Nakao
- Advanced Emergency and Critical Care Medical Center Okayama University Hospital Okayama Japan
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Zacharia BE, Kahn S, Bander ED, Cederquist GY, Cope WP, McLaughlin L, Hijazi A, Reiner AS, Laufer I, Bilsky M. Incidence and risk factors for preoperative deep venous thrombosis in 314 consecutive patients undergoing surgery for spinal metastasis. J Neurosurg Spine 2017; 27:189-197. [PMID: 28574332 DOI: 10.3171/2017.2.spine16861] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors of this study aimed to identify the incidence of and risk factors for preoperative deep venous thrombosis (DVT) in patients undergoing surgical treatment for spinal metastases. METHODS Univariate analysis of patient age, sex, ethnicity, laboratory values, comorbidities, preoperative ambulatory status, histopathological classification, spinal level, and surgical details was performed. Factors significantly associated with DVT univariately were entered into a multivariate logistic regression model. RESULTS The authors identified 314 patients, of whom 232 (73.9%) were screened preoperatively for a DVT. Of those screened, 22 (9.48%) were diagnosed with a DVT. The screened patients were older (median 62 vs 55 years, p = 0.0008), but otherwise similar in baseline characteristics. Nonambulatory status, previous history of DVT, lower partial thromboplastin time, and lower hemoglobin level were statistically significant and independent factors associated with positive results of screening for a DVT. Results of screening were positive in only 6.4% of ambulatory patients in contrast to 24.4% of nonambulatory patients, yielding an odds ratio of 4.73 (95% CI 1.88-11.90). All of the patients who had positive screening results underwent preoperative placement of an inferior vena cava filter. CONCLUSIONS Patients requiring surgery for spinal metastases represent a population with unique risks for venous thromboembolism. This study showed a 9.48% incidence of DVT in patients screened preoperatively. The highest rates of preoperative DVT were identified in nonambulatory patients, who were found to have a 4-fold increase in the likelihood of harboring a DVT. Understanding the preoperative thrombotic status may provide an opportunity for early intervention and risk stratification in this critically ill population.
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Affiliation(s)
| | | | - Evan D Bander
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Gustav Y Cederquist
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - William P Cope
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | | | | | - Anne S Reiner
- Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center; and
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Liu Y, Xu H, Liu F, Lv Z, Kan S, Ning G, Feng S. Meta-analysis of heparin therapy for preventing venous thromboembolism in acute spinal cord injury. Int J Surg 2017; 43:94-100. [PMID: 28579397 DOI: 10.1016/j.ijsu.2017.05.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/22/2017] [Accepted: 05/29/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Venous thromboembolism (VTE) is a frequent complication in patients with acute spinal cord injury (SCI) and may have serious consequences. This study aimed to assess the efficacy and safety of heparin and low-molecular-weight heparin (LMWH) venous thromboprophylaxis in patients with acute SCI. METHODS PubMed, Web of Science, EMBASE and the Cochrane library were searched from January 1980 to August 2016. The primary outcome was the incidence of VTE. Secondary outcomes included the incidences of Deep-vein thrombosis (DVT), pulmonary embolism (PE) and major bleeding. RESULTS A total of 11 studies including 1605 patients qualified for inclusion. Four studies evaluated the efficacy of heparin treatment compared with placebo or no treatment. There were significant differences between the two treatments, and the summary RR was 0.35 (95% confidence interval (CI) 0.15-0.87; P = 0.02). Seven studies compared low dose unfractionated heparin (LDUH) with LMWH. The incidence of VTE was not significantly different between the two treatments (RR 1.09, 95% CI 0.63-1.89; P = 0.76). There were no differences in the incidence of major bleeding with unfractionated heparin versus LMWH (summary RR 1.32, 95% CI 0.62-2.84; P = 0.47). CONCLUSIONS In this meta-analysis, heparin exhibited protective effects compared with placebo or no treatment with respect to the occurrence of VTE; there were no differences between LMWH and unfractionated heparin with ret to thromboembolism prophylaxis efficacy. LMWH did not reduce the risk of bleeding compared with LDUH.
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Affiliation(s)
- Yang Liu
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Hong Xu
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Feifei Liu
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Zenghui Lv
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Shunli Kan
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Guangzhi Ning
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
| | - Shiqing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, China.
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Cheng X, Zhang L, Xie NC, Xu HL, Lian YJ. Association between small-intestinal bacterial overgrowth and deep vein thrombosis in patients with spinal cord injuries. J Thromb Haemost 2017; 15:304-311. [PMID: 27930853 DOI: 10.1111/jth.13583] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 01/15/2023]
Abstract
Essentials Gastrointestinal dysfunction and vein thrombosis are complications after spinal cord injuries (SCI). We assess the deep vein thrombosis (DVT) and small intestinal bacterial overgrowth (SIBO) in SCI. 76 of the 377 SCI patients were DVT positive (20.2%) and 145 were defined as SIBO positive (38.5%). This study defines an association between SIBO and DVT in patient with SCI. SUMMARY Background Gastrointestinal dysfunction and vein thrombosis are well-known acute complications after spinal cord injuries (SCIs). Objective To determine the frequency and risk factors for deep vein thrombosis (DVT) and small-intestinal bacterial overgrowth (SIBO) in patients with SCI. Methods A total of 377 consecutive eligible SCI patients tested for SIBO with the glucose hydrogen/methane breath test from January 2011 to December 2015 and who had also undergone venous ultrasound study for suspected DVT were evaluated within 3 months after admission. Results Seventy-six of the 377 SCI patients were DVT-positive (20.2%; 95% confidence interval [CI] 16.1-24.2%), and 145 were SIBO-positive (38.5%; 95% CI 29.9-59.0%). Among the 76 DVT-positive patients, 60 were SIBO-positive and 16 were SIBO-negative. The difference was statistically significant (41.4% versus 6.9%; odds ratio [OR] 5.99; 95% CI 3.15-9.33). Among the 145 SIBO-positive patients, 60 were DVT-positive and 85 were DVT-negative. The difference was statistically significant (78.9% versus 28.2%; OR 2.88; 95% CI 2.12-4.47). In the stepwise multivariate logistic regression, a family history of venous thrombosis (OR 2.32; 95% CI 1.60-3.79), chronic kidney disease (OR 2.99; 95% CI 1.73-5.08) and the presence of SIBO (OR 3.72; 95% CI 1.97-6.62) remained associated with DVT. Conclusions These data support an association between SIBO and DVT in SCI patients. Further studies should be carried out with respect to the relationship between SIBO and DVT.
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Affiliation(s)
- X Cheng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - L Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - N-C Xie
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - H-L Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
| | - Y-J Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, P. R. China
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Liu L, Liu YB, Sun JM, Hou HF, Liang C, Li T, Qi HT. Preoperative deep vein thrombosis in patients with cervical spondylotic myelopathy scheduled for spinal surgery. Medicine (Baltimore) 2016; 95:e5269. [PMID: 27858894 PMCID: PMC5591142 DOI: 10.1097/md.0000000000005269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The prevalence of deep vein thrombosis (DVT) and its risk factors in patients with cervical spondylotic myelopathy (CSM) before spinal surgery are poorly understood. We investigated this association with a retrospective cross-sectional study. PATIENTS CONCERNS The study cohort consisted of all consecutive patients with CSM who were scheduled for spinal surgery at our institution from 2013 to 2015. DVT was defined as an intraluminal filling defect in a lower extremity vein identified by Doppler ultrasonography. OUTCOMES Of the 396 patients with CSM, 16 (4%) had DVT. Compared with patients without preoperative DVT, patients with preoperative DVT were older (62.75 ± 8.79 vs 53.03 ± 10.95 years, P = 0.001), had higher D-dimer concentrations (2.23 ± 4.15 vs 0.43 ± 0.90 mg/L, P = 0.04), had experienced longer duration of CSM (7.56 ± 7.08 vs 4.01 ± 6.37 months, P = 0.03), had lower Japanese Orthopaedic Association lower limb motor dysfunction scores (1.68 ± 1.25 vs 2.54 ± 0.91, P = 0.01), and had a history of ischemic cardiovascular events (33.3% vs 2.1%, P = 0.02). The area under the curve for the ability of D-dimer levels to predict DVT was 0.858 (95% confidence interval: 0.764-0.951; P < 0.0001). A D-dimer level of 0.54 mg/L detected DVT with a sensitivity and specificity of 87.5% and 83.2%, respectively. Abnormal D-dimer levels and ischemic cardiovascular events history were independent predictors of DVT. CONCLUSION Patients with CSM who were scheduled for surgery often presented with preoperative DVT. Preoperative vascular screening should be considered for patients with CSM, especially for those who are older, have had longer duration of CSM, have poor lower limb mobility, and have a heart disease history. Inferior vena cava filter insertion and anticoagulation treatments should be considered for CSM patients with preoperative DVT.
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Affiliation(s)
- Le Liu
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan
- Department of Orthopaedic Surgery, People's Liberation Army 148 Hospital, Zibo
| | - Yan-Bin Liu
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan
- Department of Orthopaedic Surgery, Liaocheng People's Hospital, Liaocheng
| | - Jian-Min Sun
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan
- Correspondence: Jian-Min Sun, Department of Spine, Shandong Provincial Hospital, Shandong University, 9677 Jingshi Road, Jinan 250013, Shandong Province, P.R. China (e-mail: )
| | - Hai-Feng Hou
- Institute of Epidemiology, Taishan Medical University, Taian
| | - Chen Liang
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan
| | - Tao Li
- Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan
| | - Heng-Tao Qi
- Department of Ultrasound, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong Province, P.R. China
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