Risk assessment and management of preoperative venous thromboembolism following femoral neck fracture

作者：Zenan Xia, Ke Xiao, Wei Zhu, Bin Feng, Baozhong Zhang, Lin Jin, Wenwei Qian, Jin Jin, Na Gao, Guixing Qiu, Xi-Sheng Weng · 发表于：Journal of Orthopaedic Surgery and Research · 年份：2018 · DOI：10.1186/s13018-018-0998-4 · 被引用次数：56 · 研究领域：Venous Thromboembolism Diagnosis and Management、Hip and Femur Fractures、Nutrition and Health in Aging

BACKGROUND: Limited studies are available to investigate the prevalence of preoperative venous thromboembolism (VTE) in elderly patients with femoral neck fractures. Our primary aim was to determine the incidences of VTE and its risk or protective factors in such patient population. The secondary objective was to evaluate the need of therapeutic anticoagulation for isolated calf muscular venous thrombosis (ICMVT) prior to femoral neck fracture surgery. METHODS: This is a retrospective case-control study, including 301 femoral neck fracture patients who were admitted to our institution between January 2014 and March 2017. Bilateral Doppler ultrasonography was performed in each of the patients as a preoperative VTE screening. The event rate of VTE was calculated, and significant risk or protective factors were determined by using a multivariate logistic regression model. Patients with ICMVT were divided into anticoagulation and no anticoagulation groups to assess the efficacy and safety of preoperative therapeutic anticoagulation. Intraoperative blood loss, drainage volume, blood transfusion, perioperative hemoglobin change, and rate of thrombosis extension were compared between the two groups. RESULTS: The overall preoperative incidence of VTE in patients with femoral neck fracture was 18.9% (57/301), in which deep vein thrombosis (DVT) was 18.9% and pulmonary embolism (PE) was 1%. Among the DVT cases, 77.2% (44/57) were ICMVTs. Multiple fractures (odds ratio [OR] = 9.418; 95%...