| Incidence and natural history of below-knee deep venous thrombosis in high-risk trauma patients. | |
| | |
MedLine Citation:
|
PMID: 12478026 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Venous thromboembolic disease remains a difficult problem in the trauma patient population. The purpose of this study was to delineate the incidence and natural history of below-knee deep venous thrombosis (BKDVT) in high-risk trauma patients. METHODS: Patients were stratified into risk categories (low, high, or very high) for deep venous thrombosis on the basis of an institutional practice management guideline and known risk factors. All at-risk patients received either sequential compression devices (SCDs) or subcutaneous heparin (SQH) compounds, and high-risk patients also underwent weekly surveillance by duplex scanning. Very-high-risk patients had prophylactic inferior vena cava (IVC) filter placement. This prospective, observational study examines the duplex results on all high-risk patients. Data regarding method of prophylaxis, the incidence of proximal propagation on serial duplex examinations, and changes in management (anticoagulation or IVC filter placement) were collected on the high-risk patients who developed a BKDVT. RESULTS: Between March 1997 and June 2001, 601 patients were stratified into the high-risk category and underwent a total of 1,109 duplex examinations. Eighty-five patients (14.1%) had 113 BKDVTs. These patients underwent a total of 212 duplex examinations; all patients developed their BKDVTs within 34 days. Weekly incidence was 40 (47.1%), 25 (29.4%), 15 (17.6%), 1 (1.2%), and 4 (4.7%) for weeks 1 through 5, respectively. SCDs, SQH compounds, and SCDs with SQH compounds were used on 73, 3, and 9 patients, respectively. In 4 of 85 (4.7%) patients, the BKDVT propagated proximally to an above-knee location in 4 to 8 days. Two of these patients were anticoagulated, and two underwent placement of an IVC filter. One patient (1.2%) with a BKDVT that had not propagated on duplex study developed a pulmonary embolus. CONCLUSION: Patients identified as high-risk by our practice management guideline had a 14.1% incidence of a BKDVT; 94.1% were diagnosed within the first 3 weeks of hospitalization. Proximal propagation occurred in 4.7% and led to changes in management. Serial duplex examination of the BKDVT alone, rather than systemic anticoagulation or IVC filter placement, appears to be a reasonable treatment alternative. |
| | |
Authors:
|
Richard P Sharpe; Rajan Gupta; Vicente H Gracias; John P Pryor; Fredric M Pieracci; Patrick M Reilly; C William Schwab |
Related Documents
:
|
11372666 - Prospective study on the usefulness of lung scan in patients with deep vein thrombosis ... 9821026 - Out-patient treatment of acute deep vein thrombosis. 20670476 - Impact of jak2v617f mutation on thrombosis and myeloid transformation in essential thro... 16912336 - Venous thromboembolism: application and effectiveness of the american college of chest ... 15334396 - The microbiology and antimicrobial resistance patterns in chronic rhinosinusitis. 22454446 - Daptomycin experience in critical care patients: results from a registry (april). |
Publication Detail:
|
Type: Comparative Study; Journal Article |
Journal Detail:
|
Title: The Journal of trauma Volume: 53 ISSN: 0022-5282 ISO Abbreviation: J Trauma Publication Date: 2002 Dec |
Date Detail:
|
Created Date: 2002-12-12 Completed Date: 2003-01-09 Revised Date: 2006-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 0376373 Medline TA: J Trauma Country: United States |
Other Details:
|
Languages: eng Pagination: 1048-52 Citation Subset: AIM; IM |
Affiliation:
|
Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Age Distribution Aged Aged, 80 and over Bandages Cohort Studies Critical Care Female Follow-Up Studies Heparin / administration & dosage Humans Incidence Injury Severity Score Male Middle Aged Primary Prevention / methods Prospective Studies Risk Assessment Risk Factors Sex Distribution Thrombophlebitis / epidemiology*, etiology, prevention & control Wounds and Injuries / complications*, diagnosis |
| Chemical | |
Reg. No./Substance:
|
9005-49-6/Heparin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Pelvic radiography in blunt trauma resuscitation: a diminishing role.
Next Document: Early injection of high-dose recombinant factor VIIa decreases blood loss and prolongs time from inj...