Clinical value of blood D-dimers in lower extremity deep venous thrombosis in patients with severe combined abdominal trauma
DOI:
https://doi.org/10.14739/2310-1210.2020.2.200625Keywords:
abdominal injures, deep vein thrombosis, D-dimerAbstract
Aim. To establish sensitivity and specificity of deep vein thrombosis detection in patients with severe combined abdominal trauma by studying cross-linked fibrin degradation products (D-dimer) using erythrocyte agglutination SimpliRED® technology.
Materials and methods. We analyzed the treatment results of 105 patients with severe combined abdominal trauma who underwent surgery inLvivThoraco-AbdominalTraumaCenter (Surgical Department No. 1), Traumatology and Neurosurgery Departments of the Lviv City Emergency Hospital in 2012–2017.
Results. The sensitivity and specificity of lower extremity deep venous thrombosis detection in patients with severe combined abdominal trauma was established by studying D-dimers as well as their dynamics. Mandatory inclusion criteria for the study were: negative result of the D-dimer test upon admission, absence of instrumental and clinical signs of lower extremity deep venous thrombosis. The examination was performed prior to the operation or mini-invasive methods of diagnostics (laparoscopy) and on day 3 and 7 after. The high value of the method is explained by its maximum adaptation to the conditions of urgent surgery; it does not require specific inhibitors, does not depend on blood sampling technology or platelet count and can be performed in a few minutes. A positive result, which indicated the active fibrinolysis, was evaluated within 2 min by erythrocyte agglutination in a test cell and the latter absence in a control one. The D-dimer test was positive in 78 (74.3 %) patients in the study group. The peak of positive test results was observed on the 5th day after surgery. In all the injured with lower extremity deep venous thrombosis, a strong positive test result was revealed, which was manifested by erythrocyte agglutination at the 5–20 sec and the presence of D-dimers for a long time (an average of 19.3 ± 7.1 days). In the low-risk group of deep vein thrombosis and embolism by J. Caprini, the positive test was detected in 6 (5.7 %) patients, in the moderate and high-risk groups – in 28 (26.7 %) and 44 (41.9 %), respectively.
Conclusions. The method of D-dimers detection in blood by SimpliRED® technology showed a rather high sensitivity in patients with severe combined abdominal trauma of 82.3 %, but low specificity of 32.3 %. In the absence of prophylaxis, the incidence of deep vein thrombosis in patients with severe combined abdominal trauma was 25.7 %. The method of ultrasonic compression angioscanning of the lower extremity veins verified the proximal vein thrombosis predominance – 74.1 %. The risk of thrombus fragmentation and potential pulmonary thromboembolism was detected in 13.7 % of patients.
References
Cullinane, D., Jawa, R., Como, J., Moore, A., Morris, D., Cheriyan, J., Guillamondegui, O., Goldberg, S., Petrey, L., Schaefer, G., Khwaja, K., Rowell, S., Barbosa, R., Bass, G., Kasotakis, G., & Robinson, B. (2019). Management of penetrating intraperitoneal colon injuries: A meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma. Journal of Trauma and Acute Care Surgery, 86(3), 505-515. https://doi.org/10.1097/ta.0000000000002146
van Rij, A. M., Hill, G., Krysa, J., Dutton, S., Dickson, R., Christie, R., Smillie, J., Jiang, P., & Solomon, C. (2013). Prospective Study of Natural History of Deep Vein Thrombosis: Early Predictors of Poor Late Outcomes. Annals of Vascular Surgery, 27(7), 924-931. https://doi.org/10.1016/j.avsg.2012.09.018
Baron, T. H., Kamath, P. S., & McBane, R. D. (2013). Management of Antithrombotic Therapy in Patients Undergoing Invasive Procedures. New England Journal of Medicine, 368(22), 2113-2124. https://doi.org/10.1056/nejmra1206531
Khimich, S., Chemerys, O., & Varyvoda, E. (2018). The scale of assessment the severity of injuries of the patients with the polytrauma suffering from obesity. European Journal of Medical Technologies, 1(18), 16-20. http://www.medical-technologies.eu/upload/4_the_scale_of_assessment_the_severity_-_khimich.pdf.
Laredo J., & Lee B. B. (2018). Venous Physiology and Pathophysiology. In C. Chaar (Ed.), Current Management of Venous Diseases (pp. 23-35). Springer, Cham. https://doi.org/10.1007/978-3-319-65226-9_2
King, D. R. (2019). Initial Care of the Severely Injured Patient. New England Journal of Medicine, 380(8), 763-770. https://doi.org/10.1056/nejmra1609326
Adam, S. S., Key, N. S., & Greenberg, C. S. (2009). D-dimer antigen: current concepts and future prospects. Blood, 113(13), 2878-2887. https://doi.org/10.1182/blood-2008-06-165845
Caprini, J. A. (2005). Thrombosis Risk Assessment as a Guide to Quality Patient Care. Disease-a-Month, 51(2-3), 70-78. https://doi.org/10.1016/j.disamonth.2005.02.003
Elf, J. L., Strandberg, K., Nilsson, C., & Svensson, P. J. (2009). Clinical probability assessment and D-dimer determination in patients with suspected deep vein thrombosis, a prospective multicenter management study. Thrombosis Research, 123(4), 612-616. https://doi.org/10.1016/j.thromres.2008.04.007
Comerota, A. J., & Paolini, D. (2007). Treatment of Acute Iliofemoral Deep Venous Thrombosis: A Strategy of Thrombus Removal. European Journal of Vascular and Endovascular Surgery, 33(3), 351-360. https://doi.org/10.1016/j.ejvs.2006.11.013
Guyatt, G. H., Akl, E. A., Crowther, M., Schünemann, H. J., Gutterman, D. D., & Lewis, S. Z. (2012). Introduction to the ninth edition: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2 Suppl.), 48S-52S. https://doi.org/10.1378/chest.11-2286
Zhang, M., He, Q., Wang, Y., Pang, S., Wang, W., Wang, D., Shi, P., Zhao, W., & Luan, X. (2019). Combined penetrating trauma of the head, neck, chest, abdomen and scrotum caused by falling from a high altitude: A case report and literature review. International Emergency Nursing, 44, 1-7. https://doi.org/10.1016/j.ienj.2019.01.001
Johnston, L. R., Jessie, E. M., & Bradley, M. J. (2018). Abdominal Trauma. In J. Galante, M. Martin, C. Rodriguez, W. Gordon (Eds.), Managing Dismounted Complex Blast Injuries in Military & Civilian Settings (pp. 121-133). Springer, Cham. https://doi.org/10.1007/978-3-319-74672-2_10
Schouten, H. J., Geersing, G. J., Koek, H. L., Zuithoff, N. P. A., Janssen, K. J. M., Douma, R. A., van Delden, J. J. M., Moons, K. G. M., & Reitsma, J. B. (2013). Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. BMJ, 346, Article f2492. https://doi.org/10.1136/bmj.f2492
Yang, B., Bundkirchen, K., Krettek, C., Relja, B., & Neunaber, C. (2019). Traumatic injury pattern is of equal relevance as injury severity for experimental (poly)trauma modeling. Scientific Reports, 9(1), Article 5706. https://doi.org/10.1038/s41598-019-42085-1
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