Factor V Leiden and Postoperative Deep Vein Thrombosis in Patients Undergoing Open Roux-en-Y Gastric Bypass Surgery

Background: Patients undergoing bariatric surgery are at risk for deep venous thrombosis (DVT) and fatal pulmonary embolus. In the presence of genetic hypercoagulable disorders, accepted methods of DVT prophylaxis utilizing sequential compression devices and subcutaneous unfractionated heparin may not be adequate to prevent DVT or fatal PE. Methods and Results: 3 morbidly obese patients are described who underwent open Roux-en-y gastric bypass and either had a previous diagnosis of Factor V Leiden or developed thrombosis in the presence of standard prophylaxis. Each was found to have the most common point mutation for Factor V Leiden, R506Q. All 3 patients had prophylactic inferior vena caval filters placed to prevent recurrent PE. Conclusion: The presence of venous thromboembolism either without known risk factors or in the presence of standard perioperative prophylaxis for DVT should warrant a hypercoagulable work-up. Inferior vena caval filter placement is indicated in the presence of a hypercoagulable disorder prior to surgical intervention in the morbidly obese population. The recent literature is reviewed.     

髋臼骨折术后下肢深静脉血栓形成的多因素分析

目的 分析影响髋臼骨折术后下肢深静脉血栓形成(DVT)的危险因素.方法 对102髋臼骨折术后DVT发生情况进行分析.术前及术后7～10d均用彩色多普勒检查双下肢深静脉血流通畅情况及DVT的发生,并对11项临床因素与人工关节置换术后DVT形成的相关性进行分析.结果 髋臼骨折术后发生DVT有18例,DVT发生率为17.65%(18/102).经Logistic多因素回归分析,与DVT相关的因素有6个,其中年龄、肥胖、静脉曲张及手术方式使术后发生DVT的风险分别增加到4.075、7.803、46.176和4.251倍(P＜0.05);硬膜外麻醉和踝泵练习使术后发生DVT的风险减少到0.121和0.114倍(P＜0.01).结论 年龄和肥胖是人工关节术后发生DVT的危险因素,而硬膜外麻醉和踝泵练习则是术后发生DVT的保护因素.髋臼骨折术后无症状DVT的大量存在,提示术后最好常规行双下肢彩色多普勒检查,一旦有DVT发生,及时治疗,防止发生致命性肺栓塞.     

Preoperative Incidence of Deep Vein Thrombosis after Hip Fractures in Korean

Background

The purpose of the current study was to investigate the incidence of preoperative deep vein thrombosis (DVT) after hip fractures in Korea.

Methods

In this prospective study, we enrolled 152 Korean geriatric patients who had suffered hip fractures due to a simple fall and were hospitalized between January 2013 and December 2013. There were 52 male and 100 female patients, and their mean age was 78.2 years. There were 96 trochanteric fractures and 56 femoral neck fractures. All patients were examined for DVT: 26 by ultrasonography and 126 by computed tomography venography. The patients having DVT underwent inferior vena cava filter insertion before the surgical intervention.

Results

Preoperatively, none of the patients had any signs or symptoms of DVT; however, 4 patients were identified as having asymptomatic DVT. The overall incidence of DVT was 2.6% (4/152). The mean time to arrival at emergency room after injury was 32.6 hours. Mean time elapsed to undergo surgery after hospitalization was 24.9 hours. The average time to hospitalization after injury was 237 hours for patients with DVT versus 27.5 hours for patients without DVT. DVT developed within 72 hours in two of the 137 patients (1.4%) and after 72 hours in two of the remaining 15 patients (13.3%) hospitalized.

Conclusions

While the preoperative incidence of DVT after hip fractures was relatively low (2.6%) in the Korean geriatric population, we confirmed that getting no treatment within 72 hours after injury increased the incidence of DVT. Thus, we conclude from this study that a workup for DVT should be considered in cases where admission or surgery has been delayed for more than 72 hours after injury.     

乌司他丁联合血塞通通过干预凝血活化因子表达预防髋关节置换术前 PTS及术后 DVT形成的研究

目的:探究乌司他丁联合血塞通对凝血活化因子表达的影响及其在预防髋关节置换术前高凝状态(PTS)及术后下肢深静脉血栓(DVT)形成的效果。方法:选取我院2016年4月—2018年4月收治的120例行髋关节置换术的患者作为本次研究对象,将其分为观察组和对照组,各60例。对照组患者术前采用低分子肝素治疗、术后采用血栓通治疗,观察组患者采用乌司他丁联合血塞通进行治疗。比较DVT发生率,比较两组患者入院时及术前4 h的活化部分凝血活酶时间(APTT)、血小板计数(PLT)、凝血酶原时间(PT)水平变化。比较麻醉诱导前(Ta)、手术开始后5 min(Tb)、手术开始后30 min(Tc)、术后1 h(Td)患者血浆血栓素B2(TXB2)、11去氢血栓烷B(DH-TXB2)、凝血酶敏感蛋白(TSP)、β血小板球蛋白(β-TG)、血小板α颗粒膜蛋白(GMP-140)水平。比较两组患者入院时、术后即刻、术后3 d、术后21 d时血清CRP、同型半胱氨酸、D-二聚体水平;比较两组患者治疗前后全血黏度、纤维蛋白原、血细胞比容等指标变化。统计不良反应发生情况。结果:观察组患者术后下肢静脉血栓发生率低于对照组(13.3%vs.40.0%,χ2=10.921,P<0.001)。对照组患者术前4 h PLT水平较入院时降低。术后即刻两组患者CRP、同型半胱氨酸、D-二聚体水平均较治疗前升高(P<0.05)。Tc、Td比较,观察组TXB2、DH-TXB2、TSP均低于对照组。术后3、21 d天逐渐降低(P<0.05);治疗前和术后即刻时,两组间CRP、同型半胱氨酸、D-二聚体差异无统计学意义;术后3、21d,观察组均低于对照组,差异有统计学意义(P<0.05)。治疗后观察组全血黏度、纤维蛋白原、血细胞比容等均低于对照组(P>0.05)。两组均无严重不良反应发生。结论:采用乌司他丁联合血塞通能够通过降低凝血因子TXB2、DH-TXB2、TSP水平,降低术后CRP、同型半胱氨酸、D-二聚体水平,改善血流动力学指标,预防DVT形成。     

Incidence of Deep Vein Thrombosis and Pulmonary Embolism after Achilles Tendon Rupture

Background  

The use of venous thromboembolism prophylaxis after an Achilles rupture is controversial. The rates of reported deep vein thrombosis (DVT) range from 6.3% to 34%. There is no agreement regarding prophylactic therapy after an Achilles tendon rupture.     

A Nationwide Analysis of Postoperative Deep Vein Thrombosis and Pulmonary Embolism in Colon and Rectal Surgery

There are limited data regarding predictive factors of postoperative venous thromboembolism (VTE) in patients undergoing colorectal resection. We sought to identify associations between patient comorbidities and postoperative VTE in colorectal resection. The National Surgical Quality Improvement Program (NSQIP) database was used to examine clinical data of patients experiencing postoperative VTE after colorectal resection from 2005 to 2011. Multivariate analysis using logistic regression was performed to quantify risk factors of VTE. We sampled 116,029 patients undergoing colorectal resection. The rate of VTE was 2 % (2,278) with 0.2 % (182) having deep vein thrombosis (DVT) and pulmonary embolism (PE). The first week after operation was the most common time for postoperative VTE. A significant number of patients suffering DVT and PE were diagnosed after index hospital discharge (PE 34.6 %, DVT 29.3 %). The most important risk factors identified for DVT include (P?2 (adjusted odds ratio (AOR) 1.77) and hypoalbuminemia (serum albumin level <3.5 mg/dl) (AOR 1.69). The most important factors had associations with PE include (P?P?=?0.01) and stage 4 cancer (AOR 1.29, P?=?0.02) have associations with DVT. Open colorectal procedures have higher risk of DVT compared to laparoscopic procedures (AOR 1.33, P?相似文献   

Deep Vein Thrombosis Following Hip Surgery: Relation to Activated Factor X Inhibitor Activity: Effect of Heparin and Dextran

Activated factor X inhibitor (FXaI) activity was measured with a newly developed method during operation and during the postoperative period in 60 patients undergoing total hip replacement. The patients were randomly allotted to three groups. In two groups the effect of prophylactic treatment with dextran and low dose heparin were evaluated, while the third group served as a control. Postoperative deep vein thrombosis was diagnosed with plethysmography and venography and related to observed changes in inhibitor activity. The frequency of deep vein thrombosis was found to be 25, 47 and 33 per cent in the three groups respectively. With the test system for measurements of FXaI-activity which made it possible to determine both the overall ability of the plasma to neutralize FXa and the activity independent of any accelerator or antagonist of XaI-activity, it was possible to demonstrate inhibitor consumption in all groups including the heparin treated group where the overall inhibitor activity was increased. A marked decrease in inhibitor activity was usually observed in the patients developing postoperative thrombosis in the control group, while in the other groups the relationship was less clear.     

Deep Vein Thrombosis Following Hip Surgery: Relation to Activated Factor X Inhibitor Activity: Effect of Heparin and Dextran

Activated factor X inhibitor (FXaI) activity was measured with a newly developed method during operation and during the postoperative period in 60 patients undergoing total hip replacement. The patients were randomly allotted to three groups. In two groups the effect of prophylactic treatment with dextran and low dose heparin were evaluated, while the third group served as a control. Postoperative deep vein thrombosis was diagnosed with plethysmography and venography and related to observed changes in inhibitor activity. The frequency of deep vein thrombosis was found to be 25, 47 and 33 per cent in the three groups respectively. With the test system for measurements of FXaI-activity which made it possible to determine both the overall ability of the plasma to neutralize FXa and the activity independent of any accelerator or antagonist of XaI-activity, it was possible to demonstrate inhibitor consumption in all groups including the heparin treated group where the overall inhibitor activity was increased. A marked decrease in inhibitor activity was usually observed in the patients developing postoperative thrombosis in the control group, while in the other groups the relationship was less clear.