Objective To investigate the early diagnosis of lower l imb deep vein thrombosis (DVT) after major orthopedic surgeries. Methods From October 2005 to June 2009, color doppler sonography and hemorheology detection were carried out for 62 cases undergoing first total hip arthroplasty (THA), 14 cases undergoing total knee arthroplasty (TKA), and 86 cases undergoing hip fractures surgery (HFS) before operation and 1, 7, 14 days after operation. The plasma D-dimerlevels of the DVT were also examined for the THA patients before operation and 3 days after operation. Of all cases, therewere 89 males and 73 females, aged from 34 to 74 years (51.5 years on average). After operation, all the patients were treated with the regular low molecular weight heparin sodium against DVT. Results After operation, 17 cases (10.5%) developed DVT, including 8 THA cases, 1 TKA case, and 8 HFS cases. Preoperative color doppler sonography showed no abnormal echo, normal b blood flow signal, and normal periodical variation in vein blood flow without regurgitation. Postoperative examinations showed that the vascular occlusion of common femoral vein and popl iteal vein occurred in DVT patients. There were significant differences (P lt; 0.05) in whole blood viscosity between patients with DVT and without DVT after 1, 14 days and no significant difference (P gt; 0.05) before operation and 7 days after operation. There was no significant difference (P gt; 0.05) in plasma viscosity and erythrocyte aggregation index, between patients with DVT and without DVT pre- and postoperation. There was significant difference (P lt; 0.05) in erythrocyte deformation index between patients with DVT and without DVT 14 days after operation. The preoperative plasma D-dimer levels of patients with DVT and without DVT were (372.00 ± 148.62) ng/mL and (369.00 ± 141.03) ng/mL, respectively, showing no significant difference (P gt; 0.05); the 3 days postoperatively levels were (574.00 ± 217.29) ng/mL and (391.00 ± 120.16) ng/mL, respectively, showing significant difference (P lt; 0.05). Conclusion Color doppler sonography in combination of hemorheology and plasma D-dimer examination can be beneficial for the early diagnosis of DVT in major orthopedic surgeries.
ObjectiveTo evaluate the safety and efficacy of rivaroxaban for prevention of deep vein thrombosis (DVT) in patients with preoperative abnormal D-dimer after total knee arthroplasty (TKA). MethodsBetween August and September 2013,60 consecutive patients with varus knee osteoarthritis undergoing unilateral TKA were enrolled in the study.According to the preoperative D-dimer level,the patients were divided into 2 groups:D-dimer normal group (control group,n=41) and D-dimer abnormal group (test group,n=19).No significant difference was found in gender,age,body mass index,and preoperative knee range of motion between 2 groups (P>0.05).All patients underwent conventional primary TKA and anticoagulation therapy with rivaroxaban to prevent DVT.The tourniquet use time,postoperative hospitalization time,and total hospitalization time were compared between 2 groups.At 1,3,and 5 days after operation,prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),fibrinogen (FIB),and D-dimer were measured.Wound complications and DVT were observed. ResultsThe postoperative hospitalization time of the test group was significantly longer than that of the control group (t=2.327,P=0.031),while the tourniquet use time and total hospitalization time showed no significant difference between 2 groups (P>0.05).All the patients were followed up 6-8 months (mean,7.2 months).Wound complications occurred in 3 cases (7.3%) of the control group and in 2 cases (10.5%) of the test group,showing no significant difference (χ2=0.175,P=0.676).Color ultrasonography showed no pulmonary embolism and DVT at 6 weeks after TKA.There were significant differences in PT,TT,and FIB between at pre- and post-TKA in the same group,but no significant difference was found between 2 groups.The APTT and D-dimer had significant differences between at pre- and post-TKA in the same group,and between groups.There was no significant interaction effect between time and group for each index. ConclusionPreoperative abnormal D-dimer level should not be regarded as a contraindication for TKA.The risks of DVT and wound complications in patients with abnormal D-dimer level are similar to patients with normal D-dimer level using rivaroxaban administration after TKA.It is unnecessary to conventional monitor D-dimer and other coagulation and hemorrhage laboratory tests in the patients after TKA.
Objective To investigate the pathogenesis of deep vein thrombosis (DVT) after total hip arthroplasty (THA) and the preventive effectiveness of low molecular weight heparin (LMWH). Methods The occurrence condition of DVT in 90 cases undergoing THA treated with LMWH between February 2003 and March 2004 was restrospectively analyzed. Among 90 cases, 39 were treated with LMWH at a dose of 5 000 U/day (high dose group) and 51 at a dose of 2 500 U/day (low dose group). Another 90 cases undergoing THA without LMWH treating between February 2002 and February 2003 were used as control group. There was no significant difference in gender, age, illness cause, course of disease, or the type of prosthesis among 3 groups (P gt; 0.05). Results DVT occurred in 19 cases (21.1%) of control group, in 2 cases (5.1%) of high dose group, and in 5cases (9.8%) of low dose group, showing significant differences between two treated groups and control group (P lt; 0.05), but no significant difference between two treated groups (P gt; 0.05). There was no significant difference in gender, age (gt; 65 years and ≤ 65 years), pathogen (trauma and bone disease) of each group, as well as of the same type patients within 3 groups (P gt; 0.05). The DVT incidence rate in the patients with bone cement artificial joint was significantly higher than that in the patients with non-bone cement artificial joint (P lt; 0.05), but there was no significant difference in the same type patients within 3 groups (P gt; 0.05). The postoperative blood loss in high dose group, low dose group, and control group was (463.5 ± 234.2), (342.4 ± 231.6), and (288.2 ± 141.6) mL; showing no significant difference between the high and low dose groups, between low dose and control groups (P gt; 0.05), while showing significant difference between high dose and control groups (P lt; 0.05). Conclusion The DVT incidence rate in THA patients with bone cement artificial joint is high; LMWH can reduce the DVT incidence rate and has good safety.
Objective To explore the results of thrombolytic therapy of acute deep vein thrombosis of lower extremity. Methods The clinical data of 126 patients with acute deep vein thrombosis of lower extremity treated conservatively from Dec.1999 to Feb.2004 were analyzed retrospectively. Results All patients were divided into three groups: 26 of central, 33 of surrounding and 67 of combined by Doppler sonography. Combined medication was adopted in all cases, in which 85 cases (67.5%) were clinically cured, 34 cases (27.0%) had good results, and 5 cases (4.0%) recovered partially. Two cases (1.6%) didn’t get better. The total effective rate was 98.4% (124/126). Conclusion Most patients with acute deep vein thrombosis of lower extremity can get satisfied results with conservative treatment including thrombolysis and anticoagulation. Early diagnosis and appropriate medication are crucial.
Objective To understand the preventive effect of pneumatic compression therapy on deep vein thrombosis (DVT) in lower limbs of patients with spinal cord injury. Methods Patients with spinal cord injury who transferred from Orthopedics Department to Rehabilitation Department undergoing rehabilitation in the First Affiliated Hospital of University of Science and Technology of China and discharged from April 2017 to December 2020 were retrospectively included. According to the contents of the medical order of the case data, the patients were divided into treatment group and control group. The intervention method of the treatment group was pneumatic compression therapy and conventional rehabilitation treatment, and the control group was conventional rehabilitation treatment. Multivariate logistic regression was used for statistical analysis to explore the association of pneumatic compression therapy and the risk of DVT in patients with spinal cord injury. Results Finally, 153 patients were enrolled, including 71 cases in the treatment group and 82 cases in the control group. After rehabilitation therapy, DVT occurred in 10 cases (14.1%) in the treatment group and 21 cases (25.6%) in the control group. There was no significant difference in incidence of DVT between the two groups (χ2=3.129, P=0.077). After six months of follow-up, DVT occurred in 11 cases (15.5%) in the treatment group and 12 cases (14.6%) in the control group. There was no significant difference in incidence of DVT between the two groups (χ2=0.022, P=0.822). D-dimer [odds ratio (OR) =1.104, 95% confidence interval (CI) (1.036, 1.175), P=0.002] and age [OR=1.081, 95%CI (1.040, 1.124), P<0.001] were independent risk factors for the risk of DVT after treatment. Pneumatic compression therapy was a protective factor for the risk of DVT [OR=0.210, 95%CI (0.075, 0.591), P=0.003]. Age [OR=1.057, 95%CI (1.008, 1.108), P=0.023] was an independent risk factor for the risk of DVT after six months. The effect of pneumatic compression therapy was not statistically significant (P=0.393). Conclusions After spinal cord injury, it is necessary to strengthen the management of high serum D-dimer state, especially the risk of DVT in elderly patients. Pneumatic compression therapy could be used as a treatment measure to reduce risk of DVT in patients with spinal cord injury during hospitalization, however, the preventive effect after half a year needs to be further studied.
OBJECTIVE To evaluate the efficacy and safety of low molecular weight heparin(LMWH) in prophylaxis of postoperative deep vein thrombosis (DVT) following hip and knee surgery. METHODS From April 1997 to October 1998, 46 patients undergoing hip and knee orthopedic procedures were randomized into 2 groups for studying. The following eligibility criteria were applied: age over 40 years old, no recently history of venous thromboembolism (over 3 months), normal result of preoperative hemostasis test and normal result of Doppler examination of the lower extremities. One group was control group and the other group received subcutaneously a low molecular weight heparin(Fraxiparine) with anti-factor X, activity of 41 IU/kg.day for three days, then 62 IU/kg.day from the 4th day to 10th day. All patients had venegraphy performed in the operated leg at 4 to 7 days after surgery. RESULTS eight patients(34.8%) developed DVT in the control group of 23 patients and 1 patient (4.3%) in the experimental group, also of 23 patients(P lt; 0.05). Two groups had no any bleeding complications. CONCLUSION The low molecular weight heparin is safe and effective in preventing postoperative deep vein thrombosis in patients following hip and knee surgery.
Objective To explore clinical effect and safety of rivaroxaban in treatment of acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs. Methods The clinical data of 60 patients with acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs, collected from January 2010 to March 2017 in Hunan Provincial People’s Hospital, were retrospectively analyzed. According to the different treatment, these patients were randomly divided into a rivaroxaban group and a control group (traditional warfarin anticoagulation), with 30 patients in each group. The clinical effect and safety were compared between two groups on the 10th day, 20th day and 30th day after treatment. Results Compared with the control group, maximum short axis diameter, ratio of right and left ventricles, systolic pulmonary artery pressure, and main pulmonary artery diameter measured by CTPA and echocardiography in the rivaroxaban group were not significantly different on the 10th day, 20th day and 30th day after treatment. However, the intragroup differences were statistically significant at different timepoint (P<0.05). Levels of N-terminal-pro-brain natriuretic peptide of two groups after treatment were significantly reduced on the 10th day, 20th day and 30th day after treatment, and the values of PO2 were significantly increased on the 10th day and 20th day after treatment (P<0.05), but no significant differences were found in the values of PO2 on 20th day and 30th day after treatment. D-dimer in the two groups was obviously increased on the 10th day after treatment but significantly declined on the 20th day and 30th day after treatment (all P<0.05). These changes were predominant in the rivaroxaban group. Conclusion Rivaroxaban is effective and safe for acute pulmonary thromboembolism at moderate risk with deep vein thrombosis of lower limbs, and worthy of clinical implementation and application.
Objective To discuss and evaluate the value of insertion of inferior vena cava filter in treating lower extremity deep venous thrombosis (DVT). Methods Inferior vena cava filters were placed in 46 patients with lower extremity DVT prior treatment, 20 in which were treated by therapy with anticoagulation and thrombolysis, and therapy with pressure gradient, and the other 26 patients by operation and thrombolysis therapy, and therapy with pressure gradient. Whether patients occurred pulmonary embolism was observed and the form and site of filters were monitored by periodic fluoroscopy. Results Inferior vena cava filters were placed successfully in all patients, 38 cases were implanted permanence inferior vena cava filter, 8 cases were implanted temporary inferior vena cava filter. Symptoms and signs of DVT disappeared or remitted in 44/46 patients after treatment. None of pulmonary embolism was occurred. Follow up 2-24 months (average 13 months) for 36 cases with permanence inferior vena cava filter, there was no complication of the filter and pulmonary embolism occurred. Conclusions The method of inserting inferior vena cava filter is simple and safe, which can prevent pulmonary embolism effectually to offer sufficient safeguard for the treatment of DVT.
ObjectiveTo summarize diagnostic strategies of unilateral lower limb swelling. MethodThe clinical data of 357 patients hospitalized with unilateral lower limb swelling from March 2013 to October 2014 in our department were analyzed retrospectively. ResultsThree hundred and seven (86.0%) patients were admitted to hospital within 2 weeks since the symptom onset (acute swelling), the most common cause (281 cases) was lower extremity deep vein thrombosis (DVT), other causes included infection (11 cases), hematoma (7 cases), lymphatic obstruction (4 cases), iliac vein compression syndrome (2 cases), pelvic tumor compression (1 case), arteriovenous fistula (1 case). Etiology for chronic swelling contained lower extremity DVT (33 cases), arteriovenous fistula (5 cases), lymphatic obstruction (5 cases), Klippel-Trenaunay syndrome (3 cases), pelvic tumor compression (3 cases), iliac vein compression syndrome (1 case). Up to 60.5% (26/43) lower limb swelling which were not due to DVT had histories of misdiagnosis as DVT. Nine cases of lymphatic obstruction were secondary to malignant tumor itself or the sequel of treatment. Three hundred and thirty-eight (94.6%) patients were received lower limb doppler ultrasound, while 308 patients (91.9%) were diagnosed. Fifty-nine patients needed further CT venography (CTV) or CT angiography (CTA), 10 patients were received radionuclide lymphoscintigraphy to be diagnosed. ConclusionsAlthough DVT is the main cause of unilateral lower limb swelling, the lower limb swelling which is not due to DVT is frequently misdiagnosed and belatedly treated. Considering the complexity and reciprocal overlapping for the etiology of lower limbs swelling, developing a appropriate diagnosis strategy is important. Apart from history taking and physical examination, color doppler ultrasound for the lower limb is suggested to be the preferred imaging examination mean. Pelvic cavity screening for occupancy lesions and iliac vein should be evaluated synchronously if possible. For cases which can't be diagnosed by ultrasound, CTV, CTA, or radionuclide lymphoscintigraphy could be important supplement to assist the diagnosis.
Objective To analyze the influence of the body mass index (BMI) and age on deep vein thrombosis (DVT) after the total hip arthroplasty(THA) or total knee arthroplasty(TKA) in Chinese patients who received prophylactic treatment for DVT. Methods We used a randomized clinical case-control study. From April 2004 to August 2004, weperformed THA and TKA for 95 patients (128 hips and knees). There were 27 men and 68 women with an average age of 60 years (range, 23-78) at surgery, and withan average BMI of 25.88 kg/m2 (range, 14.34-40.39) before surgery. All the patients were given low-molecular-weight heparin for 7-10 days pre-and postoperatively to prevent DVT. Color Doppler ultrasonography was used to detect DVT of bilateral lower extremities in all the patients before operation and 7-10 days after operation.The patients were divided into 4 groups according to their BMI:the non-obese group (BMI≤25.00 kg/m2), the overweight group (BMI, 25.01-27.00 kg/m2), the obese group (BMI, 27.01-30.00 kg/m2), and the morbidly obese group (BMIgt;30.00 kg/m2); and they were also divided into 4 groups according to their ages (≤40, 4160, 61.70, gt;70 yr) so as to analyze the influence of the BMI and age on DVT. Results The total incidence ofDVT in all the patients was 47.4% (45/95) and the incidence of proximal DVT was 3.2%. Forty-five patients had DVT and 50 patients had no DVT. The average BMI of the patients with DVT was significantly higher than that of the patients with no DVT (Plt;005). The overweight, obese, and morbidly obese patients had an odds ratio of 7.04, 4.8,and 9.6 for DVT compared with the nonobese patients (P＜0.05); but the obese group had a less risk than the other 2 groups.The 41-60, 61-70, and gt;70-year-old patients had an odds ratio of 24.0, 38.2, and 24.4 for DVT compared with the ≤40year-old patients (P＜0.05). Conclusion Obesity (BMIgt;25 kg/m2) and an increasing age (gt;40 yr) are identified as statistically significant risk factors for DVT after THA or TKA, and patients aged 61-70 years are more likely tohave DVT than the other patients. We should pay more attention to those obesity and aged patients when they are undergoing the total joint replacement, and we should give them enough prophylaxis and closely observe the symptoms in their bilateral lower extremities after operation, taking ultrasonography or venography to check DVT if necessary, so that we can give them prompt treatment and prevent fatal pulmonary thromboembolism.