Screening for venous thrombotic events in patients presenting with pelvis and acetabular fractures: A new practice based on a prospective study

Abstract

Introduction: Pelvic fractures are complex fractures associated with a high risk of venous thromboembolic complications (VTE) and up to a 10% risk of fatal pulmonary embolism. We aimed to reduce perioperative morbidity and mortality using a systematic screening protocol and secondly to evaluate this protocol and identify VTE risk factors. Methods: This was a prospective monocentric study involving 100 consecutively enrolled patients. The protocol included a venous ultrasound examination of the inferior vena cava and lower limbs and abdominopelvic CT venography within 48 h prior to surgery. The evaluation criteria were the mortality and complication rates. Secondary endpoints were the rate of VTE events and the identification of risk factors. Results: One patient died on D1 postoperatively of a massive pulmonary embolism. Migration of a vena cava filter was reported for another. No thrombotic recurrence or hemorrhagic complications were reported. The rate of VTE events was 21%, of which 90% were pre-operative asymptomatic events. CT venography did not show superiority over ultrasound. Patients with greater fracture displacement, preoperative infection, higher platelet counts, or having had a preoperative transfusion were at a higher risk of developing deep vein thrombosis (DVT). Conclusions: The rate of asymptomatic VTE events in pelvic fractures is extremely high and leads to propose the following recommendations: (1) they should be preoperatively investigated by ultrasound and (2) a vena cava filter must be placed in cases of proximal DVT and the surgery postponed to allow anticoagulation treatment for at least 48 h, regardless of the type of thrombosis. Level of evidence: Level II. Study type: Diagnostic test.

Keywords

• Acetabular fracture
• Pelvic fracture
• Prevention
• Thromboprophylaxis
• Venous thromboembolic disease