Incidence and risk factor for preoperative deep vein thrombosis (DVT) in isolated calcaneal fracture, a prospective cohort study. Issue 5 (July 2021)

• Record Type: Journal Article
• Authors: Meng, Hongyu; Zhu, Yanbin; Zhang, Junzhe; Li, Junyong; Zhao, Kuo; Zhang, Yingze; Chen, Wei
• Is Part Of: Foot and ankle surgery. Volume 27:Issue 5(2021)
• Page Start: 510
• Page End: 514
• Publication Date: 2021-07
• Subjects: DVT -- Calcaneal fracture -- Epidemiology -- Throboprophylaxis; Foot -- Surgery -- Periodicals; Ankle -- Surgery -- Periodicals; Ankle -- surgery -- Periodicals; Foot -- surgery -- Periodicals; Ankle -- Surgery; Foot -- Surgery; Periodicals; Electronic journals; 617.58
• DOI: 10.1016/j.fas.2020.06.007
• Languages: English
• ISSNs: 1268-7731

Abstract

Highlights: The preoperative DVT of calcaneal fracture is low in prevalence, and over 80% of them were distal and all of them were asymptomatic, therefore, routine throboprophylaxis is not recommended. The mean time from injury to DVT occurrence was 5.3 days, and each day delay was associated with 23% increased risk of DVT, which indicated the importance of early detection. Emphasis should be given in older patients with delay to admission and elevated plasma D-dimer level for targeted detection of DVT and rapid therapeutic intervention. Abstract: Backgrounds: Deep vein thrombosis (DVT) occurring during the preoperative waiting period may affect the prognosis of traumatic patients, but there still lack of relevant data. This study aimed to address the preoperative DVT in isolated calcaneal fractures. Methods: Patients who presented with isolated calcaneal fracture and received preoperative Duplex ultrasound scanning of bilateral lower extremities for detection of DVT between October and December 2018 were eligible for inclusion. Relevant data were prospectively collected, including demographics, comorbidities, lifestyles, injury, and laboratory biomarkers at admission. Univariate analyses were used to compare the difference of each variable between patients with and without DVT. Multivariate logistics regression analysis was used to identify the independent risk factors for DVT. Results: Totally, 770 patients met the criteria and were included, and 24 (3.1%) had preoperative DVT diagnosed at mean of 5.3 days after injury, all of which were asymptomatic. Among patients with DVTs, 36 thrombi were found and 29 (80.6%) were in distal veins. Eight patients had DVTs in multiple veins, but no patients had bilateral DVTs. The multivariate analyses showed older age (≥58 vs <58 years, OR = 3.84), delay from injury to DUS (in each day, OR = 1.23) and elevated plasma D-dimer level (≥1.79 vs <1.79 mg/L, OR = 2.53) were independent risk factors associated with DVT. Conclusions: Due to low prevalence of DVT in isolated fracture, routine throboprophylaxis is not recommended. However, emphasis should be given in older patients with delay to admission and elevated plasma D-dimer level for targeted detection of DVT and rapid therapeutic intervention.