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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Deep vein thrombosis in orthopedic surgery
Marcella Calfon1, Ali Seddighzadeh, Gregory Piazza
1Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston Massachusetts, USA. mcalfon@partners.org
Summary
Orthopedic surgery patients with deep vein thrombosis (DVT) are more prone to calf DVT despite fewer comorbidities. Prophylaxis rates for venous thromboembolism were insufficient in both orthopedic and general surgery groups.
Area of Science:
- Vascular Surgery
- Thrombosis Research
- Patient Outcomes
Background:
- Deep vein thrombosis (DVT) is a significant risk following surgery.
- Understanding risk factors and prophylaxis effectiveness is crucial for patient care.
- Comparing DVT characteristics and management between orthopedic and general surgery patients provides valuable insights.
Purpose of the Study:
- To compare the incidence, characteristics, and prophylaxis of DVT in patients undergoing major orthopedic surgery versus general surgery.
- To identify specific vulnerabilities and treatment gaps in orthopedic DVT patients.
Main Methods:
- Prospective registry of consecutive ultrasound-confirmed DVT patients.
- Comparison of 315 orthopedic surgery patients with 618 general surgery patients.
- Analysis of patient demographics, comorbidities, DVT location, and prophylaxis use.
Main Results:
- Orthopedic patients had fewer central venous catheters and lower rates of congestive heart failure, cancer, and diabetes.
- Extremity discomfort and erythema were more common in orthopedic patients; dyspnea was less common.
- Higher use of graduated compression stockings, low-molecular-weight heparin, and warfarin for prophylaxis in orthopedic patients.
- Orthopedic patients had a significantly higher frequency of calf DVT (38.4% vs. 2.1%).
- Inadequate prophylaxis was observed in 28% of patients in both groups.
Conclusions:
- Despite fewer comorbidities, orthopedic surgery patients with DVT are highly vulnerable to calf DVT.
- Venous thromboembolism prophylaxis rates were inadequate across both surgical groups, highlighting a critical need for improvement.
- Further research into optimized DVT prevention strategies for orthopedic patients is warranted.
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