Date: Sunday, November 5, 2017
Session Title: Orthopedics, Low Back Pain and Rehabilitation Poster
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Deep venous thrombosis (DVT) can lead to a venous thromboembolism and increase the risk of a pulmonary thromboembolism (PE). PE is one of the most common causes of death in hospitalized surgical patients.Although there have been some prospective studies regarding the prevalence of DVT on Doppler ultrasound examinations of the lower extremities, there have not been any prospective studies in which three consecutive Doppler ultrasound examinations were performed to detect DVT during the perioperative period. The purpose of the present study was to prospectively evaluate the occurrence of DVT in patients with osteoporotic fractures of the proximal femur, based on the results of examinations involving three consecutive ultrasound scans. In addition, the usefulness of the D-dimer level as a predictor of DVT was investigated.
Methods: This study was a single-center prospective study. Eighty-seven patients (14 males and 73 females) between the ages of 46 and 95 years with osteoporotic fractures of the proximal femur were enrolled. All patients were asymptomatic in terms of their clinical DVT findings. Three Doppler ultrasound examinations of the lower extremities were conducted in each case: on admission, one day before surgery, and one week after surgery. The period from admission to surgery ranged from 2 to 7 days (mean: 5.3 days).The D-dimer level was measured at one week after surgery and its relationship with the presence/absence of DVT was evaluated by calculating sensitivity, specificity, positive predictive, and negative predictive values.
Results: DVT was detected in 16 patients (2 patients on admission, 8 patients one day before surgery, and 6 patients one week after surgery). The overall prevalence of DVT in the perioperative period was 18.4% (16/87). As for the characteristics of the patients that did and did not develop DVT, there were no significant differences between the two groups.When the D-dimer cut-off level was set at 4.3 μg/ml, the sensitivity and negative predictive value reached 100%, while the specificity was 15.5%, and the positive predictive value was 21.1%. A receiver operating characteristic (ROC) curve was drawn, and the optimal D-dimer cut-off level was examined. The ROC curve was closest to the upper left corner when the D-dimer cut-off level was 12.2 μg/ml. At that point, the sensitivity, specificity, positive predictive value, and negative predictive value were 62.5%, 70.4%, 32.3%, and 89.3%, respectively.
Conclusion: In this prospective study, DVT was detected in 2 patients on admission, 8 patients one day before surgery, and 6 patients one week after surgery. As DVT can occur at any moment, performing repeated Doppler ultrasound examinations in the perioperative period is useful for quickly detecting DVT, which can cause PE.As for the D-dimer level, its sensitivity and negative predictive value reached 100% at a cut-off level of 4.3 μg/ml. Therefore, D-dimer assays could be a useful screening tool for DVT and might be a suitable substitute for Doppler ultrasound examinations.
To cite this abstract in AMA style:Nakaseko K, Mayumi N. Usefulness of Consecutive Doppler Ultrasound Examinations for Detecting Deep Venous Thrombosis during the Perioperative Period in Patients with Osteoporotic Fractures of the Proximal Femur [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/usefulness-of-consecutive-doppler-ultrasound-examinations-for-detecting-deep-venous-thrombosis-during-the-perioperative-period-in-patients-with-osteoporotic-fractures-of-the-proximal-femur/. Accessed November 20, 2018.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/usefulness-of-consecutive-doppler-ultrasound-examinations-for-detecting-deep-venous-thrombosis-during-the-perioperative-period-in-patients-with-osteoporotic-fractures-of-the-proximal-femur/