Does Fracture Site Impact DVT Risk?

A retrospective cohort study published in BMJ Open evaluated the factors of perioperative deep vein thrombosis (DVT) in traumatic fracture patients following orthopedic surgery.

“Deep vein thrombosis (DVT) is a serious complication of the major orthopaedic surgery, especially to lower extremities, which could potentially result in significant morbidity and possible mortality for the patients with traumatic fracture,” the researchers wrote. “The incidence of perioperative DVT could reach 50%–60%, and seriously it may cause pulmonary embolism (PE) after trauma.”

Eligible cases included patients who were surgically treated for fracture from May 2016 through February 2017 at Honghui Hospital in Hawaii. Researchers examined the correlation between perioperative DVT and preoperative time, fracture sites, D-dimer value, and chronic diseases (hypertension, diabetes, and coronary disease). They applied x² test, independent sample t test, and regression analysis.

Inclusion criteria included age ≥ 50 years, receipt of the same prophylactic procedures during the postoperative period (low molecular heparin via hypodermic injection), and graduation from physical prophylaxis and early ambulation 24–48 hours postoperatively. Patients were excluded if they had missing or incomplete medical records; if they suffered hemorrhagic stroke, aortic dissection, cerebrovascular disease, or other vascular anomalies; if they had previous vascular surgery; if they were taking LMH or rivaroxaban anticoagulant agent for other diseases at admission; if they had malignant neoplasms; if they had uncontrolled hypertension; if they had underlying coagulopathy and severe cardiopulmonary dysfunction; and if a senior physician did not review their ultrasound images.

The final analysis included 462 traumatic fracture patients: 337 DVT patients and 125 non-DVT patients; mean ages were 70.49 ± 11.38 and 71.66 ± 12.53 years, respectively. Patients with DVT had significantly longer preoperative times compared to patients without DVT patients (7.14 ± 5.51 days vs. 5.45 ± 3.75 days, P < 0.01). Among the total 462 patients, most (351) had a hip fracture. The remaining fractures were: femoral shaft fracture, 37; tibiofibular or tibial plateau fracture, 50; patella fracture, 22; and the rest were pelvis fracture.

“In addition, up to 71.2% of patients with DVT suffer a hip fracture, 11.9% patients were tibiofibula fracture and 10.4% DVT cases have femoral shaft fracture, showing that hip fracture group presented with the highest rate of DVT,” the study authors wrote.

The study authors further found “that preoperative D-dimer value greater than 4.01 µg/mL was considered as significant predictor for perioperative DVT in patients with traumatic fracture (P<0.05).”

“Moreover, both perioperative and postoperative D-dimer levels were significantly different between DVT and non-DVT group (P<0.05), suggesting that D-dimer value was an important indicator of DVT in patients with traumatic fracture.”

There was no significant correlation between chronic diseases and DVT.

The researchers recommended, “We concluded that preoperative time, fracture sites and increased D-dimer are potential risk factors for DVT in patients with traumatic fracture; therefore, we suggest that physicians should pay more attention to the DVT detection in special fracture sites (such as hip and tibiofibula) properly and in time. In addition, for patients with selective operation due to the restricted conditions, the physicians must assess the bleeding risk of patients at first. And then combining with the D-dimer test, anticoagulant therapy should be implemented as soon as possible.”