World Journal of Surgical Research Volume No 6

Research Open Access

Identification of Prevalence of Deep Vein Thrombosis in High Risk Patients Using D-Dimer and Duplex Scan

Satyendra Kumar Tiwary, Anupam Ranjan, Ram C Shukla, Jyoti Shukla and Ajay K Khanna
World Journal of Surgical Research 2015, 4:5

Abstract

Introduction

Deep vein thrombosis (DVT) is a potentially dangerous condition that can lead to morbidity and mortality. It is often difficult to diagnose and may be lethal when allowed to progress. The true incidence of DVT is unknown and probably underestimated as many are clinically silent and present with nonspecific signs and symptoms. Though there are ample of studies about DVT in literature but very few studies are from India. We sought to study a cost effective clinical model for diagnosis and exclusion of DVT in symptomatic patients using D-dimer and duplex scan.

Methods

A prospective study of patients in high risk group for DVT without evidences of clinical thromobosis was carried out. Total 80 patients included in the study based on the Caprini stratification score and Well’s scoring system.The patients who already had a proven DVT and the patients who were receiving thromboprophylaxis were excluded. All the patients in the high and highest risk score underwent D-Dimer assay either in the post operative period or in ICU. All these patientsalso underwent color duplex scan study to see for any evidence of DVT.

Results

In this study, we found incidence of DVT in 6 cases out of 80 high risk patients. Study design had maximum 90% abdominal cases followed by 10 % orthopaedic.Total 40 (50%) cases were of malignancy and rest 50% were benign cases. None had past history of DVT or family history. Regarding illness, most of patients were suffering from periampullary carcinoma (27.5%) followed by intestinal obstruction (15%) and in stomach malignancy (10%). All DVT proved cases had Caprini score of 5 or more (highest risk group) and Wells score of ≥3( high risk group). Regarding D dimer concerned the patient who showed DVThave D dimer value ≥0.3mg/L. OutofDVT cases distal thrombus were seen in 66.67%patients involving popliteal veins and 33.33% proximal thrombus extension seen in iliac and common femoral vein . None developed pulmonary embolism.

Discussion

Thus in our setting, although many hospitalized medically-ill patients had risk factors for DVT, the absolute risk of DVT was low compared to the Caucasian population. In this study, we found 7.5% incidence of DVTin high riskpatients. More studies from India are required to confirm our findings. None developed pulmonary embolism.

Key words

Deep venous thrombosis, High risk patients, Capirini score, Wells score, D-dimer, Duplex scan




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