Prevalence of Venous Thromboembolism after Immediate Screening in Hip Fracture Patients
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Purpose: Venous thromboembolism (VTE) is a major complication for hip fracture patients, and may exist preoperatively. This study aimed to examine the prevalence of VTE after immediate screening in hip fracture patients. Materials and Methods: Hip fracture patients with an elevated level of D-dimer underwent screening for VTE using computed tomography (CT) angiography. Anticoagulation treatments were administered preoperatively to patients diagnosed with VTE, followed by administration of additional anticoagulation postoperatively. Medical records were reviewed to identify risk factors for preoperative VTE and determine the prognosis of the patients. Results: Among 524 hip fracture patients, 66 patients (12.6%) were diagnosed with VTE, including 42 patients with deep vein thrombosis (DVT), 17 patients with pulmonary thromboembolism (PTE), and 7 patients with both DVT and PTE. Of the patients with VTE, 68.2% were diagnosed within 24 hours of injury, and 33.3% of these patients had PTE. VTE patients showed a tendency toward being overweight (P<0.01) and not on anticoagulant medication (P=0.02) compared to patients without VTE. The risk of VTE was higher for femur shaft fractures (odds ratio [OR] 4.83, 95% confidence interval [CI] 2.18-10.69) and overweight patients (OR 2.12, 95% CI 1.17-3.85), and lower for patients who were previously on anticoagulants (OR 0.36, 95% CI 0.18-0.74). Patients with preoperatively diagnosed VTE were asymptomatic before and after surgery. Conclusion: Clinicians should be aware that VTE may be present within 24 hours of injury, and screening for VTE or prophylactic measures should be considered for high-risk patients.
Abstract
Purpose: Venous thromboembolism (VTE) is a major complication for hip fracture patients, and may exist preoperatively. This study aimed to examine the prevalence of VTE after immediate screening in hip fracture patients. Materials and Methods: Hip fracture patients with an elevated level of D-dimer underwent screening for VTE using computed tomography (CT) angiography. Anticoagulation treatments were administered preoperatively to patients diagnosed with VTE, followed by administration of additional anticoagulation postoperatively. Medical records were reviewed to identify risk factors for preoperative VTE and determine the prognosis of the patients. Results: Among 524 hip fracture patients, 66 patients (12.6%) were diagnosed with VTE, including 42 patients with deep vein thrombosis (DVT), 17 patients with pulmonary thromboembolism (PTE), and 7 patients with both DVT and PTE. Of the patients with VTE, 68.2% were diagnosed within 24 hours of injury, and 33.3% of these patients had PTE. VTE patients showed a tendency toward being overweight (P<0.01) and not on anticoagulant medication (P=0.02) compared to patients without VTE. The risk of VTE was higher for femur shaft fractures (odds ratio [OR] 4.83, 95% confidence interval [CI] 2.18-10.69) and overweight patients (OR 2.12, 95% CI 1.17-3.85), and lower for patients who were previously on anticoagulants (OR 0.36, 95% CI 0.18-0.74). Patients with preoperatively diagnosed VTE were asymptomatic before and after surgery. Conclusion: Clinicians should be aware that VTE may be present within 24 hours of injury, and screening for VTE or prophylactic measures should be considered for high-risk patients.
참고문헌 (32)
- Anderson FA Jr, "Risk factors for venous thromboembolism", Circulation, 107(23 Suppl 1), pp.I9~I16 (2003)
- Sevitt S, "Prevention of venous thrombosis and pulmonary embolism in injured patients. A trial of anticoagulant prophylaxis with phenindione in middle-aged and elderly patients with fractured necks of femur", Lancet, 2, pp.981~989 (1959)[DOI]
- Shin WC, "Recent updates of the diagnosis and prevention of venous thromboembolism in patients with a hip fracture", Hip Pelvis, 29, pp.159~167 (2017)[DOI]
- Nakase J, "Heparin versus danaproid for prevention of venous thromboembolism after hip surgery", J Orthop Surg(Hong Kong), 17, pp.6~9 (2009)[DOI]
- Pedersen AB, "Excess risk of venous thromboembolism in hip fracture patients and the prognostic impact of comorbidity", Osteoporos Int, 28, pp.3421~3430 (2017)[DOI]
- Kearon C, "Natural history of venous thromboembolism", Circulation, 107(23 Suppl 1), pp.I22~I30 (2003)[DOI]
- Moser KM, "Is embolic risk conditioned by location of deep venous thrombosis?", Ann Intern Med, 94(4pt 1), pp.439~444 (1981)[DOI]
- Negus D, "Natural history of postoperative deepvein thrombosis", Lancet, 2, pp.645~ (1969)[DOI]
- Geerts WH, "A prospective study of venous thromboembolism after major trauma", N Engl J Med, 331, pp.1601~1606 (1994)[DOI]
- Brown CA, "Analysis of past secular trends of hip fractures and predicted number in the future 2010-2050", J Orthop Trauma, 26, pp.117~122 (2012)[DOI]
- Schulman S, "Venous thromboembolism : past, present and future", Thromb Haemost, 117, pp.1219~1229 (2017)[DOI]
- "Collaborative overview of randomised trials of antiplatelet therapy--III: reduction in venous thrombosis and pulmonary embolism by antiplatelet prophylaxis among surgical and medical patients. Antiplatelet Trialists' Collaboration", BMJ, 308, pp.235~246 (1994)
- White RH, "Incidence and time course of thromboembolic outcomes following total hip or knee arthroplasty", Arch Intern Med, 158, pp.1525~1531 (1998)[DOI]
- The ICM-VTE Trauma Delegates, "Recommendations from the ICM-VTE : trauma", J Bone Joint Surg Am, 104(Suppl 1), pp.280~308 (2022)[DOI]
- Song K, "The preoperative incidence of deep vein thrombosis(DVT)and its correlation with postoperative DVT in patients undergoing elective surgery for femoral neck fractures", Arch Orthop Trauma Surg, 136, pp.1459~1464 (2016)[DOI]
- He SY, "Incidence and risk factors of preoperative deep venous thrombosis following hip fracture : a retrospective analysis of 293 consecutive patients", Eur J Trauma Emerg Surg, 48, pp.3141~3147 (2022)[DOI]
- Shin WC, "Preoperative prevalence of and risk factors for venous thromboembolism in patients with a hip fracture : an indirect multidetector CT venography study", J Bone Joint Surg Am, 98, pp.2089~2095 (2016)[DOI]
- Desciak MC, "Perioperative pulmonary embolism : diagnosis and anesthetic management", J Clin Anesth, 23, pp.153~165 (2011)[DOI]
- Koessler MJ, "The clinical relevance of embolic events detected by transesophageal echocardiography during cemented total hip arthroplasty : a randomized clinical trial", Anesth Analg, 92, pp.49~55 (2001)[DOI]
- White RH, "The epidemiology of venous thromboembolism", Circulation, 107(23 Suppl 1), pp.I4~I8 (2003)
- Goldhaber SZ, "Risk factors for venous thromboembolism", J Am Coll Cardiol, 56, pp.1~7 (2010)[DOI]
- Kruger PC, "Deep vein thrombosis : update on diagnosis and management", Med J Aust, 210, pp.516~524 (2019)[DOI]
- Dalen JE, "Natural history of pulmonary embolism", Prog Cardiovasc Dis, 17, pp.259~270 (1975)[DOI]
- "Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism" (2019)[URL]
- Anderson DR, "American Society of Hematology 2019 guidelines for management of venous thromboembolism : prevention of venous thromboembolism in surgical hospitalized patients", Blood Adv, 3, pp.3898~3944 (2019)[DOI]
- Falck-Ytter Y, "Prevention of VTE in orthopedic surgery patients : Antithrombotic Therapy and Prevention of Thrombosis, 9th ed : American College of Chest Physicians Evidence-Based Clinical Practice Guidelines", Chest, 141(2 Suppl), pp.e278S~325S (2012)[DOI]
- "Venous thromboembolism in adults" (2021)[URL]
- Ley EJ, "Updated guidelines to reduce venous thromboembolism in trauma patients : a Western Trauma Association critical decisions algorithm", J Trauma Acute Care Surg, 89, pp.971~981 (2020)[DOI]
- Moon KH, "Is the oral chemical prophylaxis necessary for the prevention of venous thromboembolism after joint arthroplasty in a Korean population?", Hip Pelvis, 31, pp.150~157 (2019)[DOI]
- Anderson DR, "Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty", N Engl J Med, 378, pp.699~707 (2018)[DOI]
- Flevas DA, "Thromboembolism prophylaxis in orthopaedics : an update", EFORT Open Rev, 3, pp.136~148 (2018)[DOI]
- Kabrhel C, "Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism", Acad Emerg Med, 17, pp.589~597 (2010)[DOI]
