Risk factors of postoperative deep vein thrombosis (DVT) under low molecular weight heparin (LMWH) prophylaxis in patients with thoracolumbar fractures caused by high-energy injuries

Abstract

To determine the incidence of DVT and to evaluate the risk factors of DVT under LMWH prophylaxis in patients with thoracolumbar fractures caused by high‑energy injuries postoperatively. A total of 534 patients from January 2016 to November 2019 were included in this retrospective study. Medical record data, including demographic data, perioperative variables, and laboratory results, were collected. LMWH prophylaxis was used for DVT in all the patients. The incidence and risk factors of DVT after surgery were identified by logistic regression analysis and receiver operating characteristic (ROC) curve analysis. The overall incidence of postoperative DVT was 18.91% (101/534). Three patients (0.56%) had proximal DVT and ninety-eight (18.35%) patients had distal DVT. The incidence of postoperative DVT in patients with thoracic fractures was 26.80% and 15.50% with lumbar fractures. The multivariate analysis showed that six risk factors increased the incidence of postoperative DVT, including advanced age, decreased lower extremity motor, blood transfusion, duration of bed rests, fibrinogen (FIB), and D-dimer. The ROC analysis indicated that the diagnostic value of D-dimer was highest whose area under the ROC curves (AUC) value was 0.754. Despite LMWH prophylaxis, the risk of postoperative DVT is still very high, especially in thoracic fracture. Advanced age, decreased lower extremity motor, blood transfusion, duration of bed rests, FIB, and D-dimer are risk factors for DVT. Moreover, the diagnostic value of D-dimer is the highest among these factors.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. 1.

    Saglam N, Dogan S, Ozcan C et al (2019) Comparison of four different posterior screw fixation techniques for the treatment of thoracolumbar junction fractures. World Neurosurg 123:e773–e780

    Article  Google Scholar 

  2. 2.

    Niikura T, Sakai Y, Lee SY et al (2015) D-dimer levels to screen for venous thromboembolism in patients with fractures caused by high-energy injuries. J Orthop Sci 20:682–688

    Article  Google Scholar 

  3. 3.

    Baaj AA, Downes K, Vaccaro AR et al (2011) Trends in the treatment of lumbar spine fractures in the United States: a socioeconomics perspective: clinical article. J Neurosurg Spine 15:367–370

    Article  Google Scholar 

  4. 4.

    Den Ouden LP, Smits AJ, Stadhouder A et al (2019) Epidemiology of spinal fractures in a level one trauma center in the Netherlands: a 10 years review. Spine 44:732–739

    Article  Google Scholar 

  5. 5.

    Ghobrial GM, Maulucci CM, Maltenfort M et al (2014) Operative and nonoperative adverse events in the management of traumatic fractures of the thoracolumbar spine: a systematic review. Neurosurg Focus 37:E8

    Article  Google Scholar 

  6. 6.

    Schulte LM, O'Brien JR, Bean MC et al (2013) Deep vein thrombosis and pulmonary embolism after spine surgery: incidence and patient risk factors. Am J Orthop (Belle Mead NJ) 42:267–270

    Google Scholar 

  7. 7.

    Akeda K, Matsunaga H, Imanishi T et al (2014) Prevalence and countermeasures for venous thromboembolic diseases associated with spinal surgery: a follow-up study of an institutional protocol in 209 patients. Spine 39:791–797

    Article  Google Scholar 

  8. 8.

    Hirmerova J, Seidlerova J, Subrt I et al (2013) Deep vein thrombosis and/or pulmonary embolism concurrent with superficial vein thrombosis of the legs: cross-sectional single center study of prevalence and risk factors. Int Angiol 32:410–416

    CAS  PubMed  Google Scholar 

  9. 9.

    Michiels JJ, Gadisseur A, Van Der Planken M et al (2005) A critical appraisal of non-invasive diagnosis and exclusion of deep vein thrombosis and pulmonary embolism in outpatients with suspected deep vein thrombosis or pulmonary embolism: how many tests do we need? Int Angiol 24:27–39

    CAS  PubMed  Google Scholar 

  10. 10.

    Acuña DL, Berg GM, Harrison BL et al (2011) Assessing the use of venous thromboembolism risk assessment profiles in the trauma population: is it necessary? Am Surg 77:783–789

    PubMed  Google Scholar 

  11. 11.

    Kahn SR, Shbaklo H, Lamping DL et al (2008) Determinants of health related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost 6:1105–1112

    CAS  Article  Google Scholar 

  12. 12.

    Kahn SR, Ducruet T, Lamping DL et al (2005) Prospective evaluation of health-related quality of life in patients with deep venous thrombosis. Arch Intern Med 165:1173–1178

    Article  Google Scholar 

  13. 13.

    Zhang BF, Wei X, Huang H et al (2018) Deep vein thrombosis in bilateral lower extremities after hip fracture: a retrospective study of 463 patients. Clin Interv Aging 13:681–689

    CAS  Article  Google Scholar 

  14. 14.

    Xing F, Li L, Long Y et al (2018) Admission prevalence of deep vein thrombosis in elderly Chinese patients with hip fracture and a new predictor based on risk factors for thrombosis screening. BMC Musculoskelet Disord 19:444

    CAS  Article  Google Scholar 

  15. 15.

    Markovic-Denic L, Zivkovic K, Lesic A et al (2012) Risk factors and distribution of symptomatic venous thromboembolism in total hip and knee replacements: prospective study. Int Orthop 36:1299–1305

    Article  Google Scholar 

  16. 16.

    Glotzbecker MP, Bono CM, Wood KB et al (2009) Thromboembolic disease in spinal surgery: a systematic review. Spine 34:291–303

    Article  Google Scholar 

  17. 17.

    Moayer A, Mohebali N, Razmkon A (2016) Incidence of deep vein thrombosis in patients undergoing degenerative spine surgery on prophylactic delteparin: a single center report. Bull Emerg Trauma 4:38–42

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Stannard JP, Singhania AK, Lopez-Ben RR et al (2005) Deep-vein thrombosis in high-energy skeletal trauma despite thromboprophylaxis. J Bone Joint Surg Br 87:965–968

    CAS  Article  Google Scholar 

  19. 19.

    Velmahos GC, Kern J, Chan LS et al (2000) Prevention of venous thromboembolism after injury: an evidence-based report-part II: analysis of risk factors and evaluation of the role of vena caval filters. J Trauma 49:140–144

    CAS  Article  Google Scholar 

  20. 20.

    Johanson NA, Lachiewicz PF, Lieberman JR et al (2009) American academy of orthopaedic surgeons clinical practice guideline on prevention of symptomatic pulmonary embolism in patients undergoing total hip or knee arthroplasty. J Bone Joint Surg Am 91:1756–1757

    Article  Google Scholar 

  21. 21.

    Kearon C, Kahn SR, Agnelli G et al (2008) Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 133:454–545

    Article  Google Scholar 

  22. 22.

    Cloney MB, Hopkins B, Dhillon ES et al (2018) The timing of venous thromboembolic events after spine surgery: a single-center experience with 6869 consecutive patients. J Neurosurg Spine 28(1):88–95

    Article  Google Scholar 

  23. 23.

    Rabinov K, Paulin S (1972) Roentgen diagnosis of venous thrombosis in the leg. Arch Surg 104:134–144

    CAS  Article  Google Scholar 

  24. 24.

    Yamada K, Suda K, Matsumoto Harmon S et al (2019) Rapidly progressive cervical myelopathy had a high risk of developing deep venous thrombosis: a prospective observational study in 289 cases with degenerative cervical spine disease. Spinal Cord 57:58–64

    Article  Google Scholar 

  25. 25.

    Leon L, Rodriguez H, Tawk RG et al (2005) The prophylactic use of inferior vena cava filters in patients undergoing high-risk spinal surgery. Ann Vasc Surg 19:442–447

    Article  Google Scholar 

  26. 26.

    Tetzlaff JE, Yoon HJ, O’Hara J et al (1994) Influence of anesthetic technique on the incidence of deep venous thrombosis after elective lumbar spine surgery. Reg Anesth 19:28

    Google Scholar 

  27. 27.

    Al-Dujaili TM, Majer CN, Madhoun TE et al (2012) Deep venous thrombosis in spine surgery patients:incidence and hematoma formation. Int Surg 97:150–154

    Article  Google Scholar 

  28. 28.

    Yang SD, Ding WY, Yang DL et al (2015) Prevalence and risk factors of deep vein thrombosis in patients undergoing lumbar interbody fusion surgery: a single-center cross-sectional study. Medicine (Baltimore) 94:e2205

    Article  Google Scholar 

  29. 29.

    Sansone JM, del Rio AM, Anderson PA (2010) The prevalence and specific risk factors for venous thromboembolic disease following elective spine surgery. J Bone Joint Surg Am 92:304–313

    Article  Google Scholar 

  30. 30.

    Wang TY, Sakamoto JT, Nayar G et al (2015) Independent predictors of 30-day perioperative deep vein thrombosis in 1346 consecutive patients after spine surgery. World Neurosurg 84:1605–1612

    Article  Google Scholar 

  31. 31.

    Yoshioka K, Murakami H, Demura S et al (2013) Comparative study of the prevalence of venous thromboembolism after elective spinal surgery. Orthopedics 36:223–228

    Article  Google Scholar 

  32. 32.

    Yoshioka K, Murakami H, Demura S et al (2015) Prevalence and risk factors for development of venous thromboembolism after degenerative spinal surgery. Spine 40:301–306

    Article  Google Scholar 

  33. 33.

    Matsumoto S, Suda K, Iimoto S et al (2015) Prospective study of deep vein thrombosis in patients with spinal cord injury not receiving anticoagulant therapy. Spinal Cord 53:306–309

    CAS  Article  Google Scholar 

  34. 34.

    Goel R, Patel EU, Cushing MM et al (2018) Association of perioperative red blood cell transfusions with venous thromboembolism in a north American registry. JAMA Surg 153:826–833

    Article  Google Scholar 

  35. 35.

    Jiang T, Song K, Yao Y et al (2019) Perioperative allogenic blood transfusion increases the incidence of postoperative deep vein thrombosis in total knee and hip arthroplasty. J Orthop Surg Res 14:235

    Article  Google Scholar 

  36. 36.

    Silvain J, Abtan J, Kerneis M et al (2014) Impact of red blood cell transfusion on platelet aggregation and inflammatory response in anemic coronary and noncoronary patients: the TRANSFUSION-2 study (impact of transfusion of red blood cell on platelet activation and aggregation studied with flow cytometry use and light transmission aggregometry). J Am Coll Cardiol 63:1289–1296

    Article  Google Scholar 

  37. 37.

    Akobeng AK (2007) Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr 96:644–647

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Wenyuan Ding.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wang, H., Pei, H., Ding, W. et al. Risk factors of postoperative deep vein thrombosis (DVT) under low molecular weight heparin (LMWH) prophylaxis in patients with thoracolumbar fractures caused by high-energy injuries. J Thromb Thrombolysis (2020). https://doi.org/10.1007/s11239-020-02192-7

Download citation

Keywords

  • Deep vein thrombosis
  • Low molecular weight heparin
  • Thoracolumbar fracture
  • High‑energy injury
  • Risk factor