Dose-adjusted thrombosis prophylaxis in trauma surgery according to levels of D-Dimer.
In 234 trauma surgery patients, thrombosis prophylaxis with Nadroparin-Calcium low-molecular-weight heparin (LMWH) was adjusted according to levels of D-Dimer. Basic prophylaxis was 2,850 IU per day. If D-Dimer concentrations rose above 2 mg/L after the fourth postoperative (p.o.) day, LMWH was administered twice a day. Color Doppler ultrasound was performed between the fifth and seventh p.o. days. Patients were divided into a high-risk (group 1: hip, femur, or knee replacement surgery, n=102) and a moderate-risk group (group 2: other surgery of the knee, tibia, fibula, or foot, n=132). Group 1 showed significantly higher D-Dimer levels than group 2 (p<0.001). Measurement of D-Dimer on days 2 and 4 p.o. showed a sensitivity of 100% and a specificity of 72.8% in identifying patients at risk (i.e., D-Dimer>2 mg/L after day 4 p.o.). The overall deep vein thrombosis (DVT) rate in group 1 was 3.9%, and the rate of proximal DVT was 1.96%. In group 2, one distal DVT (0.8%) occurred. The results show that D-Dimer is a useful marker to monitor p.o. coagulation activation and to manage LMWH prophylaxis in trauma surgery patients.
Peetz
D
D
Institute of Clinical Chemistry and Laboratory Medicine, University of Mainz, Germany. peetz@zentrallabor.klinik.uni-mainz.de
Hafner
G
G
Hansen
M
M
Mayer
A
A
Rippin
G
G
Rommens
P M
PM
Prellwitz
W
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000097:blood; D000990:Antithrombin III / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery; D006801:Humans; D007869:Leg Injuries / Q000150:complications; D008297:Male; D008875:Middle Aged; D017762:Nadroparin / Q000008:administration & dosage; D010447:Peptide Hydrolases / Q000378:metabolism; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors; D020246:Venous Thrombosis / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications / Q000188:drug therapy* / Q000601:surgery
D000933:Antifibrinolytic Agents; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D017762:Nadroparin; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; D000990:Antithrombin III; D010447:Peptide Hydrolases