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Predictors of preoperative deep vein thrombosis in hip fractures: A systematic review and meta-analysis

  • Takaomi Kobayashi
    Correspondence
    Corresponding author. Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, 860 Ninosekou Arita-Town Nishimatsuura-Gun, Saga 849-4141, Japan. Fax: +81 955 46 2123.
    Affiliations
    Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, 860 Ninosekou Arita-Town Nishimatsuura-Gun, Saga 849-4141, Japan

    Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
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  • Takayuki Akiyama
    Affiliations
    Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, 860 Ninosekou Arita-Town Nishimatsuura-Gun, Saga 849-4141, Japan

    Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
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  • Masaaki Mawatari
    Affiliations
    Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
    Search for articles by this author
Published:September 27, 2021DOI:https://doi.org/10.1016/j.jos.2021.08.013

      Abstract

      Background

      The predictors of preoperative deep vein thrombosis (DVT) in patients with hip fractures remain unclear. Therefore, this study describes the results of a systematic review and meta-analysis of relevant peer-reviewed literature on this topic.

      Methods

      We searched PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE for articles published in English on the predictors of preoperative DVT in hip fractures. We calculated pooled odds ratios (OR) or mean differences (MD) for the DVT groups as compared with the non-DVT groups for each variable, including gender, age, body mass index, injury side, current smoking status, time from injury to admission, time from injury to surgery, fracture type, hypertension, arrhythmia, coronary artery disease, diabetes, stroke, kidney disease, liver disease, lung disease, malignancy, rheumatoid arthritis, D-dimer, fibrinogen, activated partial thromboplastin time, prothrombin time, thrombin time, hemoglobin, albumin, total cholesterol, and triglycerides.

      Results

      We included 9 studies involving 3,123 Asian patients with hip fractures (DVT, n = 570; non-DVT, n = 2,553). Being female (OR = 1.27; 95% confidence interval [CI] 1.04–1.56; p = 0.02), being of advanced age (MD = 1.63; 95% CI 0.80–2.47; p = 0.0001), having a longer time from injury to admission (MD = 0.80; 95% CI 0.48–1.12; p < 0.00001), having a longer time from injury to surgery (MD = 2.20; 95% CI 1.53–2.88; p < 0.00001), and the presence of kidney disease (OR = 1.76; 95% CI 1.04–2.96; p = 0.03) were correlated with a high risk of DVT. However, we found no significant differences between the two groups in the other predictors.

      Conclusions

      Evidence indicates that being female, being of advanced age, having a longer time from injury to admission, having a longer time from injury to surgery, and having kidney disease are significantly correlated with a high risk of preoperative DVT in Asian patients with hip fracture. Further investigations with patients of other ethnicities are required.
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      References

        • Zuo J.
        • Hu Y.
        Admission deep venous thrombosis of lower extremity after intertrochanteric fracture in the elderly: a retrospective cohort study.
        J Orthop Surg Res. 2020 Nov; 15: 549
        • Zhang B.F.
        • Wei X.
        • Huang H.
        • Wang P.F.
        • Liu P.
        • Qu S.W.
        • Li J.H.
        • Wang H.
        • Cong Y.X.
        • Zhuang Y.
        • Zhang K.
        Deep vein thrombosis in bilateral lower extremities after hip fracture: a retrospective study of 463 patients.
        Clin Interv Aging. 2018 Apr; 13: 681-689
        • Cho Y.H.
        • Byun Y.S.
        • Jeong D.G.
        • Han I.H.
        • Park Y.B.
        Preoperative incidence of deep vein thrombosis after hip fractures in Korean.
        Clin Orthop Surg. 2015 Sep; 7: 298-302
        • Xing F.
        • Li L.
        • Long Y.
        • Xiang Z.
        Admission prevalence of deep vein thrombosis in elderly Chinese patients with hip fracture and a new predictor based on risk factors for thrombosis screening.
        BMC Muscoskel Disord. 2018 Dec; 19: 444
        • Niu S.
        • Li J.
        • Zhao Y.
        • Ding D.
        • Jiang G.
        • Song Z.
        Preoperative deep venous thrombosis (DVT) after femoral neck fracture in the elderly, the incidence, timing, location and related risk factors.
        BMC Muscoskel Disord. 2021 Mar; 22: 264
        • Fei C.
        • Wang P.F.
        • Qu S.W.
        • Shang K.
        • Yang K.
        • Li Z.
        • Zhuang Y.
        • Zhang B.F.
        • Zhang K.
        Deep vein thrombosis in patients with intertrochanteric fracture: a retrospective study.
        Indian J Orthop. 2020 Jul; 54: 101-108
        • Song K.
        • Yao Y.
        • Rong Z.
        • Shen Y.
        • Zheng M.
        • Jiang Q.
        The preoperative incidence of deep vein thrombosis (DVT) and its correlation with postoperative DVT in patients undergoing elective surgery for femoral neck fractures.
        Arch Orthop Trauma Surg. 2016 Oct; 136: 1459-1464
        • Luksameearunothai K.
        • Sa-Ngasoongsong P.
        • Kulachote N.
        • Thamyongkit S.
        • Fuangfa P.
        • Chanplakorn P.
        • Woratanarat P.
        • Suphachatwong C.
        Usefulness of clinical predictors for preoperative screening of deep vein thrombosis in hip fractures.
        BMC Muscoskel Disord. 2017 May; 18: 208
        • Feng L.
        • Xu L.
        • Yuan W.
        • Xu Z.
        • Feng Z.
        • Zhang H.
        Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery.
        BMC Anesthesiol. 2020 Apr; 20: 72
        • MacDonald D.R.W.
        • Neilly D.
        • Schneider P.S.
        • Bzovsky S.
        • Sprague S.
        • Axelrod D.
        • Poolman R.W.
        • Frihagen F.
        • Bhandari M.
        • Swiontkowski M.
        • Schemitsch E.H.
        • Stevenson I.M.
        FAITH and HEALTH Investigators. Venous thromboembolism in hip fracture patients: a subanalysis of the FAITH and HEALTH trials.
        J Orthop Trauma. 2020 Nov; 34: S70-S75
        • Bengoa F.
        • Vicencio G.
        • Schweitzer D.
        • Lira M.J.
        • Zamora T.
        • Klaber I.
        High prevalence of deep vein thrombosis in elderly hip fracture patients with delayed hospital admission.
        Eur J Trauma Emerg Surg. 2020 Aug; 46: 913-917
        • Magetsari R.
        • Dewo P.
        • Nugroho A.S.
        • Lanodiyu Z.
        Deep Vein Thrombosis in elderly patients following surgery for fracture of the proximal femur.
        Malays Orthop J. 2014 Nov; 8: 7-10
        • Brill J.B.
        • Badiee J.
        • Zander A.L.
        • Wallace J.D.
        • Lewis P.R.
        • Sise M.J.
        • Bansal V.
        • Shackford S.R.
        The rate of deep vein thrombosis doubles in trauma patients with hypercoagulable thromboelastography.
        J Trauma Acute Care Surg. 2017 Sep; 83: 413-419
        • McNamara I.
        • Sharma A.
        • Prevost T.
        • Parker M.
        Symptomatic venous thromboembolism following a hip fracture.
        Acta Orthop. 2009 Dec; 80: 687-692
        • Rosencher N.
        • Vielpeau C.
        • Emmerich J.
        • Fagnani F.
        • Samama C.M.
        • ESCORTE group
        Venous thromboembolism and mortality after hip fracture surgery: the ESCORTE study.
        J Thromb Haemostasis. 2005 Sep; 3: 2006-2014
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009 Jul 21; 6e1000097
        • Stang A.
        Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.
        Eur J Epidemiol. 2010 Jul 22; 25: 603-605
      1. Guidelines for prevention of symptomatic venous thromboembolus. Japanese Orthopaedic Association, 2017
      2. Guidelines for diagnosis, treatment and prevention of pulmonary thromboembolism and deep vein thrombosis. JCS, 2017
        • Roach R.E.
        • Cannegieter S.C.
        • Lijfering W.M.
        Differential risks in men and women for first and recurrent venous thrombosis: the role of genes and environment.
        J Thromb Haemostasis. 2014 Oct; 12: 1593-1600
        • Melgaard L.
        • Nielsen P.B.
        • Overvad T.F.
        • Skjøth F.
        • Lip G.Y.H.
        • Larsen T.B.
        Sex differences in risk of incident venous thromboembolism in heart failure patients.
        Clin Res Cardiol. 2019 Jan; 108: 101-109
        • Tanizawa Y.
        • Bando E.
        • Kawamura T.
        • Tokunaga M.
        • Makuuchi R.
        • Iida K.
        • Nanri K.
        • Yoneyama M.
        • Terashima M.
        Prevalence of deep venous thrombosis detected by ultrasonography before surgery in patients with gastric cancer: a retrospective study of 1140 consecutive patients.
        Gastric Cancer. 2017 Sep; 20: 878-886
        • Klestil T.
        • Röder C.
        • Stotter C.
        • Winkler B.
        • Nehrer S.
        • Lutz M.
        • Klerings I.
        • Wagner G.
        • Gartlehner G.
        • Nussbaumer-Streit B.
        Impact of timing of surgery in elderly hip fracture patients: a systematic review and meta-analysis.
        Sci Rep. 2018 Sep; 8: 13933
        • Lu H.Y.
        • Liao K.M.
        Increased risk of deep vein thrombosis in end-stage renal disease patients.
        BMC Nephrol. 2018 Aug; 19: 204
        • Dempfle C.E.
        • Korte W.
        • Schwab M.
        • Zerback R.
        • Huisman M.V.
        • CARDIM study group
        Sensitivity and specificity of a quantitative point of care D-dimer assay using heparinized whole blood, in patients with clinically suspected deep vein thrombosis.
        Thromb Haemostasis. 2006 Jul; 96: 79-83
        • Niikura T.
        • Sakai Y.
        • Lee S.Y.
        • Iwakura T.
        • Nishida K.
        • Kuroda R.
        • Kurosaka M.
        D-dimer levels to screen for venous thromboembolism in patients with fractures caused by high-energy injuries.
        J Orthop Sci. 2015 Jul; 20: 682-688
        • Weiss E.S.
        • Hayanga A.J.
        • Efron D.T.
        • Noll K.
        • Cornwell 3rd, E.E.
        • Haut E.R.
        Laterality of deep venous thrombosis among trauma patients: are we screening our patients adequately?.
        J Surg Res. 2007 Jul; 141: 68-71
        • Kobayashi T.
        • Lefor A.K.
        • Hotta K.
        • Morimoto T.
        • Sonohata M.
        • Mawatari M.
        Pain relief after more than 24 hours of preoperative skin traction in patients with intertrochanteric fractures: a retrospective comparative cohort study.
        Int J Orthop Trauma Nurs. 2020 May; 37: 100754
        • Miyata T.
        • Sato Y.
        • Ishikawa J.
        • Okada H.
        • Takeshita S.
        • Sakata T.
        • Kokame K.
        • Kimura R.
        • Honda S.
        • Kawasaki T.
        • Suehisa E.
        • Tsuji H.
        • Madoiwa S.
        • Sakata Y.
        • Kojima T.
        • Murata M.
        • Ikeda Y.
        Prevalence of genetic mutations in protein S, protein C and antithrombin genes in Japanese patients with deep vein thrombosis.
        Thromb Res. 2009 May; 124: 14-18