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Lin S, Alepuz A, Tritsch T, Schwartz G. Deep Vein Thrombosis Prophylaxis in Orthopedic Surgery. Cureus 2024; 16:e53726. [PMID: 38455781 PMCID: PMC10919879 DOI: 10.7759/cureus.53726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Deep vein thrombosis (DVT) is a complex and multifactorial process arising from a variety of factors, including recent surgical procedures, traumatic events, and periods of prolonged immobility. The extended period of stasis post-orthopedic surgery places patients at a notably high risk of developing DVT, and DVT-related pulmonary embolism (PE) ranks as the third most common cause of death in orthopedic surgery patients. This review examines the multifaceted risk factors contributing to the development of DVT in orthopedic patients. Additionally, it addresses the importance of DVT prophylaxis in orthopedic settings, the efficacy and safety of various prophylactic methods encompassing both mechanical and pharmacological approaches, and the economic dimensions of DVT prophylaxis, including scrutiny of cost-effectiveness and the exploration of strategies for optimization.
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Affiliation(s)
- Shu Lin
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Adrian Alepuz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Tara Tritsch
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Gary Schwartz
- Orthopedic Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
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Natour AK, Ahmed S, Kim DY, Malinzak L, Rteil A, Kabbani L. Risk of Ipsilateral Deep Vein Thrombosis After Kidney Transplantation: A Retrospective Study. Cureus 2022; 14:e24482. [PMID: 35651413 PMCID: PMC9132759 DOI: 10.7759/cureus.24482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: To investigate the incidence and characteristics of deep vein thrombosis (DVT) in kidney transplantation recipients and analyze whether the anatomical side of DVT was associated with the side of the transplanted organ. Methods: A single-center retrospective medical record review of patients who received a kidney transplant between January 2004 and July 2019 and who subsequently developed DVT. Only patients who received unilateral kidney transplants were included in the study. Patients who underwent concomitant pancreatic transplants, bilateral kidney transplants, or repeat procedures were excluded. Results: Of the 2449 kidney transplants performed during the study period, 1482 were included in the analysis (948 men [64%]; mean age 61 years). Of 606 duplex ultrasound tests, 115 results confirmed the presence of DVT. The incidence of symptomatic DVT was 4.7%. The most common time of DVT diagnosis was within four weeks after transplantation. Type 2 diabetes, heart failure, acute myocardial infarction, sepsis, chronic obstructive pulmonary disease/abnormal pulmonary function, and being confined to bed were associated with DVT after kidney transplant (all P < 0.05). Patients with ultrasound-confirmed DVT had higher mean Caprini scores than patients with negative duplex ultrasounds (P < 0.5). Approximately 53% of transplant patients with ultrasound-confirmed DVT had a 1:1 correlation of transplant side to the side of DVT. Cohen kappa statistic 0.03 indicated no correlation between the side of DVT and the side of transplant. Conclusions: The incidence of DVT after kidney transplant was lower than the incidence reported in the literature. Being confined to a bed may be a risk factor for DVT after transplant surgery. Kidney transplant recipients who had a positive duplex ultrasound had higher Caprini risk assessment scores than transplant recipients who had negative duplex ultrasounds. There was no correlation between the side of the DVT and the side of the transplant.
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Romano D, Boyle M, Isla AE, Teasdall RJ, Srinath A, Aneja A. Hypercoagulable Disorders in Orthopaedics: Etiology, Considerations, and Management. JBJS Rev 2021; 9:01874474-202110000-00003. [PMID: 34637409 DOI: 10.2106/jbjs.rvw.21.00079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Hypercoagulable disorders (HCDs) can be inherited or acquired. An HCD of either etiology increases the chance of venous thromboembolic events (VTEs). » Patients with an HCD often have the condition discovered only after surgical complications. » We recommend that patients with a concern for or a known HCD be referred to the appropriate hematological specialist for workup and treatment. » Tourniquet use in the orthopaedic patient with an HCD is understudied and controversial. We recommend that tourniquets be avoided in the surgical management of patients with an HCD, if possible. When tourniquets are applied to patients with unknown HCD status, close follow-up and vigilant postoperative examinations should be undertaken.
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Affiliation(s)
- David Romano
- Riverside Regional Medical Center, Newport News, Virginia
| | - Maxwell Boyle
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Alexander E Isla
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Robert J Teasdall
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Arjun Srinath
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
| | - Arun Aneja
- Department of Orthopaedic Surgery, University of Kentucky, Lexington, Kentucky
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Chavalparit P, Chuaychoosakoon C, Parinyakhup W, Boonriong T. Deep vein thrombosis following arthroscopic meniscal root repair: A case report. Int J Surg Case Rep 2021; 85:106193. [PMID: 34256233 PMCID: PMC8281600 DOI: 10.1016/j.ijscr.2021.106193] [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] [Received: 05/12/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Deep vein thrombosis (DVT) following arthroscopic surgery is a rare condition, especially arthroscopic meniscal surgery. There have been three reported cases of DVT after arthroscopic meniscal procedure, all related to arthroscopic meniscectomy. In this study, we reported the first case of symptomatic DVT at the level of the femoral vein to the popliteal vein following arthroscopic meniscal root repair. Case presentation The case was a 55-year-old Thai female who presented with left knee pain for 2 months after a fall. She was diagnosed as left medial meniscal root injury and had had an arthroscopic meniscal root repair. At 6 weeks post-operatively, she developed left leg swelling without pain. She was diagnosed as DVT and was initially treated with enoxaparin for three days then warfarin for three months. Conclusion We report a case of symptomatic DVT that extended from the femoral vein to the popliteal vein after arthroscopic meniscal root repair. The risks of DVT following arthroscopic surgery are aged more than 40 years old and tourniquet time more than 60 min. Symptomatic DVT can develop after arthroscopic meniscal root repair. Patients undergoing arthroscopic knee surgery should be advised to watch for signs of DVT. If the patient develops leg swelling after arthroscopic surgery, they should see their doctor immediately.
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Affiliation(s)
- Piya Chavalparit
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Chaiwat Chuaychoosakoon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla 90110, Thailand.
| | - Wachiraphan Parinyakhup
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla 90110, Thailand
| | - Tanarat Boonriong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla 90110, Thailand.
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Hadžimehmedagić A, Rovčanin B, Vranić H, Djedović M, Štraus S, Selimović T. Preoperative femoral vein velocity in maximal flexion is a predictor of deep vein thrombosis in patients undergoing total hip arthroplasty. Acta Clin Croat 2021; 59:416-423. [PMID: 34177050 PMCID: PMC8212658 DOI: 10.20471/acc.2020.59.03.04] [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: 11/30/2022] Open
Abstract
The aim of the study was to investigate if preoperative blood flow velocity in femoral vein in different positions of the hip during total hip arthroplasty (THA) is a predictor of postoperative deep vein thrombosis (DVT). In patients undergoing THA, blood flow velocity and diameter of proximal femoral vein on THA side were measured preoperatively in four flexion positions of the hip. After THA, patients were followed up for 42 days for DVT occurrence, and clinical features of patients with and without postoperative DVT were compared. The mean blood flow velocity in maximal flexion (90º+) preoperatively was significantly lower in patients with postoperative DVT (19/103) compared to patients without it (8.4±2 cm/s vs. 10.6±2.3 cm/s; p<0.001). Using the receiver operating characteristic curve analysis, the cut-off value for blood flow velocity during maximal flexion was 8.24 cm/s. In addition, anesthesia duration, duration of surgical position of the patient, body mass index, amount of blood transfused after surgery, and clinical signs of DVT were markedly different between patients with and those without postoperative DVT. Blood flow velocity in femoral vein in maximal flexion of the hip (90º+) measured prior to THA is an independent predictor of postoperative DVT.
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Affiliation(s)
| | - Bekir Rovčanin
- 1Department of Vascular Surgery, Sarajevo University Clinical Centre, Sarajevo, Bosnia and Herzegovina; 2Public Health Centre of Sarajevo Canton, Sarajevo, Bosnia and Herzegovina; 3Department of Anesthesiology, Sarajevo University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Haris Vranić
- 1Department of Vascular Surgery, Sarajevo University Clinical Centre, Sarajevo, Bosnia and Herzegovina; 2Public Health Centre of Sarajevo Canton, Sarajevo, Bosnia and Herzegovina; 3Department of Anesthesiology, Sarajevo University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Muhamed Djedović
- 1Department of Vascular Surgery, Sarajevo University Clinical Centre, Sarajevo, Bosnia and Herzegovina; 2Public Health Centre of Sarajevo Canton, Sarajevo, Bosnia and Herzegovina; 3Department of Anesthesiology, Sarajevo University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Slavenka Štraus
- 1Department of Vascular Surgery, Sarajevo University Clinical Centre, Sarajevo, Bosnia and Herzegovina; 2Public Health Centre of Sarajevo Canton, Sarajevo, Bosnia and Herzegovina; 3Department of Anesthesiology, Sarajevo University Clinical Centre, Sarajevo, Bosnia and Herzegovina
| | - Tarik Selimović
- 1Department of Vascular Surgery, Sarajevo University Clinical Centre, Sarajevo, Bosnia and Herzegovina; 2Public Health Centre of Sarajevo Canton, Sarajevo, Bosnia and Herzegovina; 3Department of Anesthesiology, Sarajevo University Clinical Centre, Sarajevo, Bosnia and Herzegovina
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Bui MH, Hung DD, Vinh PQ, Hiep NH, Anh LL, Dinh TC. Frequency and Risk Factor of Lower-limb Deep Vein Thrombosis after Major Orthopedic Surgery in Vietnamese Patients. Open Access Maced J Med Sci 2019; 7:4250-4254. [PMID: 32215072 PMCID: PMC7084020 DOI: 10.3889/oamjms.2019.369] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Deep venous thrombosis (DVT) is a prevalent complication of orthopedic surgery. According in many studies. The incidence of DVT may be up to 50% if thromboprophylaxis is not available. AIM The objective of this study was to check the degree of disease, clinical characteristics and analyzed factors in vulnerabilities with lower-limp DVT after orthopedic surgery in a Vietnam teaching hospital. METHODS Orthopedic patients who met criteria were recruited at our hospital between August 2017 and June 2018. Ultrasound was used to discovering lower-limp DVT in pre-surgery and 7 days after surgery in all patients. RESULTS The incidence of DVT after orthopedic surgery was 7.2%. Patients with older age (> 60) have a risk of 2 times higher of DVT after surgery than normal people (p < 0.05). The incidence of postoperative DVT was higher in immobile individuals > 72 hours (p < 0.05). Patients with prolonged surgical time (>120 minutes) had a higher risk of postoperative DVT than non-surgical patients' surgery (p < 0.05). CONCLUSIONS DVT remains a common complication following orthopedic surgery. Older age, immobility status, and surgical time have been found to be risky factors for the development of postoperative lower-limp DVT in orthopedic patients.
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Affiliation(s)
- My Hanh Bui
- Tuberculosis and Lung Disease Faculty, Hanoi Medical University, Hanoi, Vietnam
| | - Duong Duc Hung
- Department of General Administration, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Nguyen Hoang Hiep
- Center for Development of Curriculum and Human Resource in Health, Hanoi Medical University, Hanoi, Vietnam
| | - Le Lan Anh
- Department of Hematology, Bach Mai Hospital, Hanoi, Vietnam
| | - Toi Chu Dinh
- Department of Hematology, Bach Mai Hospital, Hanoi, Vietnam
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Peyvandi F, Mamaev A, Wang J, Stasyshyn O, Timofeeva M, Curry N, Cid AR, Yee TT, Kavakli K, Castaman G, Sytkowski A. Phase 3 study of recombinant von Willebrand factor in patients with severe von Willebrand disease who are undergoing elective surgery. J Thromb Haemost 2019; 17:52-62. [PMID: 30362288 PMCID: PMC7379610 DOI: 10.1111/jth.14313] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Indexed: 01/28/2023]
Abstract
Essentials Recombinant von Willebrand factor (rVWF) is effective in von Willebrand disease (VWD). A phase 3 study of rVWF, with/without recombinant factor VIII (rFVIII) before surgery in VWD. Overall rVWF's efficacy was rated excellent/good; rVWF was administered alone in most patients. rVWF was well-tolerated and hemostasis was achieved in patients with severe VWD undergoing surgery. SUMMARY: Background Recombinant von Willebrand factor (rVWF) has demonstrated efficacy for on-demand treatment of bleeding in severe von Willebrand disease (VWD), warranting evaluation in the surgical setting. Objectives This study (NCT02283268) evaluated the hemostatic efficacy/safety profile of rVWF, with/without recombinant factor VIII (rFVIII), in patients with severe VWD undergoing surgery. Patients/Methods Patients received rVWF 40-60 IU kg-1 , VWF ristocetin cofactor activity was measured 12-24 h before surgery. If endogenous FVIII activity (FVIII:C) target levels were achieved 3 h before surgery, rVWF was administered alone 1 h before surgery; rVWF was co-administered with rFVIII if target endogenous FVIII levels were not achieved. rVWF was infused postoperatively to maintain target trough levels. Overall and intraoperative hemostatic efficacy, the pharmacodynamics of rVWF administration and the incidence of adverse events (AEs) were assessed. Results All patients treated with rVWF for major (n = 10), minor (n = 4) and oral (n = 1) surgery had overall and intraoperative hemostatic efficacy ratings of excellent (73.3% and 86.7%) or good (26.7% and 13.3%). Most rVWF infusions (89.4%) were administered alone, resulting in hemostatically effective levels of endogenous FVIII within 6 h, which were sustained for 72-96 h; 70% (n = 7/10) of major surgeries were performed without rFVIII co-administration. Six patients reported 12 treatment-emergent AEs. Two patients each had one serious AE: diverticulitis (not treatment related) and deep vein thrombosis (sponsor-assessed as possibly treatment related). No severe allergic reactions or inhibitory antibodies were reported. Conclusions These data support the efficacy and safety profile of rVWF in patients with severe VWD undergoing elective surgery.
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Affiliation(s)
- F. Peyvandi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoAngelo Bianchi Bonomi Hemophilia and Thrombosis CenterMilanItaly
- Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
| | - A. Mamaev
- Regional State Budgetary Healthcare Institution “Regional Clinical Hospital”BarnaulAltai RegionRussian Federation
| | - J.‐D. Wang
- Center for Rare Diseases and Hemophilia CenterTaichung Veterans General HospitalTaichungTaiwan
| | - O. Stasyshyn
- SI Institute of Blood Pathology and Transfusion Medicine of NAMS of UkraineLvivUkraine
| | - M. Timofeeva
- Federal State Budgetary Research Institution “Kirov Scientific and Research Institute of Hematology and Blood Transfusion of Federal Medico‐Biological Agency of Russia”KirovRussian Federation
| | - N. Curry
- The Oxford Haemophilia and Thrombosis CentreChurchill Hospital and NIHR BRC, Blood ThemeOxfordUK
| | - A. R. Cid
- Hospital Universitario y Politécnico La Fe Hemostasia y TrombosisValenciaSpain
| | - T. T. Yee
- Royal Free London NHS Foundation TrustKatharine Dormandy Haemophilia and Thrombosis CentreLondonUK
| | - K. Kavakli
- Ege Universitesi Tip Fakultesi Hematoloji Bilim DaliBornova, IzmirTurkey
| | - G. Castaman
- Center for Bleeding Disorders and Coagulation Department of OncologyCareggi University HospitalFlorenceItaly
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Mochizuki T, Ikari K, Yano K, Hiroshima R, Ishibashi M, Okazaki K. Outcome of Direct Oral Anticoagulant Treatment for Acute Lower Limb Deep Venous Thrombosis After Total Knee Arthroplasty Or Total Hip Arthroplasty. Mod Rheumatol 2018; 29:682-686. [PMID: 30041559 DOI: 10.1080/14397595.2018.1504396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: The aim of this study was to examine the treatment outcomes of edoxaban and apixaban on deep venous thrombosis (DVT) in Japanese patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA). Methods: We examined 100 patients receiving edoxaban or apixaban to treat lower limb DVT. The primary efficacy outcome was defined as the disappearance of DVT at three months post-treatment. The primary safety outcome was the change in hemoglobin (Hb) value after two and seven days of treatment compared with baseline, which was the start of treatment with edoxaban or apixaban. Results: The primary efficacy outcome occurred in 61 of the 70 patients (87.1%) in the edoxaban group and in 28 of the 30 patients (93.3%) in the apixaban group. There was no significant difference between the edoxaban and apixaban groups in the disappearance of DVT at three months (p = .497). The change in Hb value from baseline to two days post-treatment was -0.53 ± 0.98 in the edoxaban group and -0.06 ± 0.75 in the apixaban group (p = .010). At seven days post-treatment, the changes in Hb were -0.03 ± 1.60 and 0.30 ± 0.68 (p = .007) in the edoxaban and apixaban groups, respectively. Conclusion: Edoxaban and apixaban were equivalent in efficacy. However, apixaban was superior to edoxaban in terms of the change in Hb value. In cases of major bleeding, both edoxaban and apixaban need to be used carefully when treating DVT.
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Affiliation(s)
- Takeshi Mochizuki
- a Department of Orthopedic Surgery , Kamagaya General Hospital , Kamagaya , Japan
| | - Katsunori Ikari
- b Institute of Rheumatology, Tokyo Women's Medical University , Shinjuku , Japan
| | - Koichiro Yano
- b Institute of Rheumatology, Tokyo Women's Medical University , Shinjuku , Japan
| | - Ryo Hiroshima
- a Department of Orthopedic Surgery , Kamagaya General Hospital , Kamagaya , Japan
| | - Mina Ishibashi
- a Department of Orthopedic Surgery , Kamagaya General Hospital , Kamagaya , Japan
| | - Ken Okazaki
- c Department of Orthopaedic Surgery , Tokyo Women's Medical University , Kamagaya , Japan
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Shulman RM, Buchan C, Bleakney RR, White LM. Low prevalence of unexpected popliteal DVT detected on routine MRI assessment of the knee. Clin Imaging 2015; 40:79-85. [PMID: 26603091 DOI: 10.1016/j.clinimag.2015.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/03/2015] [Accepted: 09/10/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to document the appearance and determine the prevalence of findings suspicious for popliteal vein thrombosis on magnetic resonance (MR) assessment of the knee joint. METHODS A total of 2888 MR examinations were retrospectively reviewed and classified as illustrating either normal appearing popliteal vein or findings suspicious for popliteal vein thrombosis. RESULTS A total of 2879 MR studies were assessed as having a normal appearing popliteal vein. Nine studies illustrated findings suspicious for popliteal vein thrombosis. CONCLUSION Although the prevalence of MR findings is low (0.3%), our findings reiterate the need to interrogate the popliteal vein for evidence of thrombosis.
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Affiliation(s)
- Ryan M Shulman
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital. 600 University Avenue, Toronto, ON, Canada, M5G 1X5. University of Toronto, Department of Medical Imaging; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital. 600 University Avenue, Toronto, ON, Canada, M5G 1X5. University of Toronto, Department of Medical Imaging. Current address; Gold Coast University Hospital, Cnr Parklands Drive and Olsen Avenue, Southport, Queensland, 4215, Australia.
| | - Craig Buchan
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital. 600 University Avenue, Toronto, ON, Canada, M5G 1X5. University of Toronto, Department of Medical Imaging; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital. 600 University Avenue, Toronto, ON, Canada, M5G 1X5. University of Toronto, Department of Medical Imaging. Current address; Gold Coast University Hospital, Cnr Parklands Drive and Olsen Avenue, Southport, Queensland, 4215, Australia.
| | - Robert R Bleakney
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital. 600 University Avenue, Toronto, ON, Canada, M5G 1X5. University of Toronto, Department of Medical Imaging.
| | - Lawrence M White
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital. 600 University Avenue, Toronto, ON, Canada, M5G 1X5. University of Toronto, Department of Medical Imaging.
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Jiang Y, Li J, Liu Y, Li YC, Zhang WG. Risk factors for deep vein thrombosis after orthopedic surgery and the diagnostic value of D-dimer. Ann Vasc Surg 2015; 29:675-81. [PMID: 25728333 DOI: 10.1016/j.avsg.2014.12.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/04/2014] [Accepted: 12/11/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study was prospectively designed to determine the risk factors of deep vein thrombosis (DVT) in patients who underwent different surgeries, and to evaluate the efficacy and accuracy of plasma D-dimer level as a screening test. METHODS From June 2013 to June 2014, 360 consecutive patients undergoing orthopedic surgery were evaluated. All patients underwent ultrasonography preoperatively and on postoperative day 7. Plasma D-dimer levels were estimated by latex immunoturbidimetry on the day of surgery and on postoperative days 1, 3, and 7. RESULTS Of the 360 patients in this study, 339 patients completed the analysis. Among them, DVT was confirmed in 28 (8.26%) patients based on ultrasonographic findings. Multivariate logistic analysis revealed that body mass index was an independent risk factor for developing DVT (P = 0.018) and D-dimer levels on postoperative days 1 and 7 were independently correlated with the development of DVT (P = 0.019 and P < 0.001, respectively). The receiver operating characteristic curve analysis determined that the area under the curve was largest (0.752) when using D-dimer level on postoperative day 7 as diagnostic index, and the sensitivity and specificity were 71.4% and 81.7% at the cut-off value of 6.17 μg/mL, respectively. The elevated D-dimer levels followed the same tendency toward a double-peaked distribution with peaks at days 1 and 7 postoperatively. CONCLUSION D-dimer level was a useful screening test to exclude DVT, and the cut-off values of D-dimer determined in this study will provide a reference for the absence of DVT to a certain extent.
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Affiliation(s)
- Yong Jiang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jie Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yang Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yuan-Cheng Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wei-Guo Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, China.
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