Wang et al reported a number of factors associated with preoperative deep vein thrombosis (DVT) in a patient with a hip fracture. These can help to identify a patient who may require more aggressive antithrombotic therapy. The authors are from Hebei Medical University and the Orthopaedic Research Institute of Hebei Province in China.
Patient selection: hip fracture
Predictors of deep vein thrombosis prior to surgery with OR > 2:
(1) history of thrombosis (OR 5.3)
(2) elevated serum C-reactive protein (OR 6.0)
(3) prolonged time from injury to surgery (OR 2.1)
(4) low plasma fibrinogen (elevated plasma fibrinogen has OR 0.2)
Predictors with odds ratios below 2:
(1) pulmonary disease (OR 1.6)
(2) smoking (OR 1.5)
(3) serum albumin < 35 g/L (OR 1.4)
(4) history of coronary artery disease (OR 1.3)
(5) dementia (OR 1.7)
(6) liver and kidney disease (OR 1.9)
(7) male sex (OR for female sex 0.82)
Predictors more challenging to interpret:
(1) older age (OR 0.13)
(2) high energy injury (OR 0.58)
(3) prolonged time from injury to admission (OR 0.54)
Plasma D-dimer was not found to be a risk factor, possibly due to reduced sensitivity associated with older age, trauma and comorbidities.
A patient who is ASA 1 is at lower risk for preoperative thrombosis due to the absence of the comorbid conditions.
