Vascular Medicine Fellow Jobst Vascular Institute Perrysburg, Ohio, United States
Objective: The aim of this study was to investigate if D-dimer can be used as an indicator and a monitor for VTE events in trauma patients. There is at least 30% of DVT events in trauma patients occur during the first week of hospitalization, and the incidence is even higher in immobile patients without chemoprophylaxis. Use of D-dimer for early DVT detection is well established in non-surgical patients, however due to the unsubstantiated perception of D-dimer levels being significantly elevated in all trauma patients, the D-dimer is consequently not routinely used in this population.
Methods: This is a Prospective Observational study for Adult patients admitted to a level 1 trauma center, who were expected to be immobile for at least 2 weeks were enrolled in this study. A VDU was performed every three days with simultaneous testing of the plasma concentration of D-dimer.
Results: 43 patients, 25 M, 20 F with age range 19 - 82 (Mean 47+/-17) were enrolled in this study 9 patients had VTE events(7 DVT, and 3 had PE, 1 patient had both PE and DVT), There was no significant difference in age and gender between VTE and no VTE patients (VTE patients: 4M, 5F age 30-75 (Mean 56+/-16), non-VTE patients: 21M, 15 F age 19-82 (mean 44+/-16). In terms of DVT prophylaxis, 8 patients received none for unknown reason, 29 pts had IPC, 13 pts had IPC and compression stockings, no patients received chemical anticoagulation prophylaxis. RAP score calculated for all the patients and noted to be significantly different between the two groups, the score was 4.81 +-3.40 for no VTE group and 9.8 +- 4.14 for VTE group with P value < 0.001. D-dimer level on admission was significantly elevated in the VTE group with P value of < 0.00001, D-dimer level ranged (1219.47 +/_1052.64 No VTE group - 5331.43+/-4002.06 VTE group). Of the 28.1% of patients (12 patients) who had D-dimer < 500 ng/ml on presentation only one patient developed VTE during their hospitalization. Patients with no VTE events had stable or decreasing level of D-dimer throughout hospitalization. Patients who developed DVT during their hospital stay had significant increase in D-dimer level at the time of the first positive VDU.
Conclusions: This is a preliminary results of an ongoing study that shows D-dimer can be used as: 1- An indicator of increased risk for VTE especially if it was significantly elevated on presentation in trauma patients. 2-Using D-dimer as a monitor in trauma patients can be useful to detect VTE events during spikes during their hospitalization.