Deep venous thrombosis in elderly patients as a surgical emergency at King Abdulaziz University Hospital, Jeddah, Saudi Arabia
Keywords:
Deep venous thrombosis, Elderly, Surgical emergencyAbstract
Background: Deep venous thrombosis (DVT) is a condition that occurs frequently among surgical, as well as acutely ill hospitalized medical patients, and is responsible for significant morbidity and mortality in hospitalized patients. Risk factors include older age, surgery and immobilization (as with bed rest, orthopedic casts, and sitting on long flights.
Objective: This study was conducted to identify the frequency and factors associated with occurrence of DVT among elderly patients referred to King Abdulaziz University (KAU) Hospital, Jeddah, Kingdom of Saudi Arabia.
Methods: The current study is a hospital based cross sectional study. The emergency, inpatients and outpatients’ departments at KAU hospital were reviewed. We studied all the referred elderly subjects during the study period. All elderly patients (540) referred to or admitted to the hospital departments and who were clinically suspected to have DVT and subjected to Doppler examination were included in the study. Data were analyzed using descriptive statistics and Chi square test.
Results: Based on the results of Doppler examination, DVT was detected in 97 (18.0%) of the studied elderly population. There were no significant differences in gender between patients who developed DVT and those who were negative by Doppler examination (p=0.018). Other comorbidities as diabetes, IHD and hypertension were significantly associated with the occurrence of DVT among the participants (p=0.05, 0.05 and 0.04 respectively). Furthermore, the other investigated factors such as being bed ridden, cancer, orthopedic cast and previous DVT were not significantly associated with the development of DVT among the studied elderly patients (p=0.42, 0.16, 0.45 and 0.75 respectively).
Conclusion: DVT has high prevalence in Jeddah; KSA. Thrombophilia screening should be regular for elderly patients with diabetes, hypertension and bed-ridden patients with recurrent DVT or patients with other risk factors. Knowing the most common risk factors and their significance in developing DVT is essential for early detection of DVT to prevent unwanted complications for elderlies.
References
Okuhara A, Navarro TP, Procópio RJ, Bernardes RDC, Oliveira LDCC, Nishiyama MP. Incidence of deep
vein thrombosis and quality of venous thromboembolism prophylaxis. Revista do Colégio Brasileiro de
Cirurgiões. 2014; 41(1): 2-6. doi: 10.1590/S0100-69912014000100002.
Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, et al. Prevention of venous
thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines.
Chest. 2008; 133(6_suppl): 381S-453. doi: 10.1378/chest.08-0656. PMID: 18574271.
Cook D, McMullin J, Hodder R, Heule M, Pinilla J, Dodek P, et al. Prevention and diagnosis of venous
thromboembolism in critically ill patients: a Canadian survey. Crit Care. 2001; 5(6): 336–42. doi:
1186/cc1066. PMID: 11737922, PMCID: PMC83855.
"What are the signs and symptoms of deep vein thrombosis?". National Heart, Lung, and Blood Institute.
Severinsen MT, Johnsen SP, Tjønneland A, Overvad K, Dethlefsen C, Kristensen SR. "Body height and
sex-related differences in incidence of venous thromboembolism: A Danish follow-up study". Eur J Intern
Med. 2010; 21(4): 268-72. doi: 10.1016/j.ejim.2010.03.013. PMID: 20603033.
Sajawal Ali M, Czarnecka-Kujawa K. Venous Thromboembolism in the Elderly. Current Geriatrics
Reports. 2016; 5(2): 132.
Ahmed MM, Akbar DH, Al-Shaikh AR. Deep vein thrombosis at King Abdul Aziz University Hospital.
Saudi Med J. 2000; 21(8): 762-4. PMID: 11423891.
Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ, American College of Chest
Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary:
Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians
Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl): 7S-47. doi:
1378/chest.1412S3. PMID: 22315257, PMCID: PMC3278060.
Cogo A, Bernardi E, Prandoni P, Girolami B, Noventa F, Simioni P, et al. Acquired risk factors for deep- vein thrombosis in symptomatic outpatients. Arch Intern Med. 1994; 154: 164–8. doi:
1001/archinte.1994.00420020066008. PMID: 8285811.
Lawall H, Oberacker R, Zemmrich C, Bramlage P, Diehm C, Schellong SM. Prevalence of Deep Vein
Thrombosis in Acutely Admitted Ambulatory Non-Surgical Intensive Care Unit Patients. BMC Research
Notes. 2014; 7: 431. doi: 10.1186/1756-0500-7-431. PMID: 24996222, PMCID: PMC4105515.
Oger E, Bressollette L, Nonent M, Lacut K, Guias B, Couturaud F, et al. High prevalence of asymptomatic
deep vein thrombosis on admission in a medical unit among elderly patients. Thromb Haemost. 2002;
(4): 592-7.
Magetsari R, Dewo P, Nugroho AS, Lanodiyu Z. Deep Vein Thrombosis in Elderly Patients Following
Surgery for Fracture of the Proximal Femur. Malays Orthop J. 2014; 8(3): 7-10. doi:
5704/MOJ.1411.002. PMID: 26401228, PMCID: PMC4536392.
Balogun IO, Roberts LN, Patel R, Pathansali R, Kalra L, Arya R. Clinical and laboratory predictors of deep
vein thrombosis after acute stroke. Thrombosis research. 2016; 142: 33-9. doi:
1016/j.thromres.2016.04.002. PMID: 27115860.
Chua K, Kong KH, Chan SP. Prevalence and risk factors of asymptomatic lower extremity deep venous
thrombosis in Asian neuro rehabilitation admissions in Singapore. Archives of physical medicine and
rehabilitation. 2008; 89(12): 2316-23. doi: 10.1016/j.apmr.2008.05.025. PMID: 19061744.
Ota S, Yamada N, Tsuji A, Ishikura K, Nakamura M, Ito M. Incidence and clinical predictors of deep vein
thrombosis in patients hospitalized with heart failure in Japan. Circulation Journal. 2009; 73(8): 1513-7.
doi: 10.1253/circj.CJ-08-0990.
Matsuo H, Matsumura M, Nakajima Y, Ogawa T, Tazaki J, Doi T, et al. Frequency of deep vein
thrombosis among hospitalized non-surgical Japanese patients with congestive heart failure. Journal of
cardiology. 2014; 64(6): 430-4. doi: 10.1016/j.jjcc.2014.02.028. PMID: 24755201.
Lu DY, Huang CC, Huang PH, Chung CM, Lin SJ, Chen JW, et al. Metformin use in patients with type 2
diabetes mellitus is associated with reduced risk of deep vein thrombosis: a non-randomized, pair-matched
cohort study. BMC cardiovascular disorders. 2014; 14(1): 187. doi: 10.1186/1471-2261-14-187. PMID:
, PMCID: PMC4274716.
Yamada N, Hanzawa K, Ota S, Nakamura M, Sato K, Ikura M, et al. Occurrence of deep vein thrombosis
among hospitalized non-surgical Japanese patients. Annals of vascular diseases. 2015; 8(3): 203-9. doi:
3400/avd.oa.14-00132. PMID: 26421068, PMCID: PMC4575331.
Wei J, Li W, Pei Y, Shen Y, Li J. Clinical analysis of preoperative risk factors for the incidence of deep
venous thromboembolism in patients undergoing posterior lumbar interbody fusion. Journal of orthopaedic
surgery and research. 2016; 11(1): 68. doi: 10.1186/s13018-016-0403-0.
Kang JH, Keller JJ, Lin YK, Lin HC. A population-based case-control study on the association between
rheumatoid arthritis and deep vein thrombosis. Journal of vascular surgery. 2012; 56(6): 1642-8. doi:
1016/j.jvs.2012.05.087. PMID: 23085092.
Holst AG, Jensen G, Prescott E. Risk Factors for Venous Thromboembolism. Circulation. 2010; 121: 1896- 903. doi: 10.1161/CIRCULATIONAHA.109.921460.
Fletcher H, Wharfe G, Williams N, Pedican M, Brooks A, Scott P, et al. Venous thromboembolism in
Jamaican women: experience in a university hospital in Kingston. West Indian Medical Journal. 2009;
(3): 243-9. PMID: 20043532.
Sun K, Wang C, Pang B, Yang Y, He W, Chen T, et al. Study on the risk factors of deep venous thrombosis
in acute hospitalized stroke patients. Zhonghua Liu Xing Bing Xue Za Zhi. 2004; 25(12): 1019-23. PMID:
Low FZ, Yeow RCH, Yap HK, Lim JH. Study on the use of soft ankle-foot exoskeleton for alternative
mechanical prophylaxis of deep vein thrombosis. Rehabilitation Robotics (ICORR). 2015; 11-4. doi:
1109/ICORR.2015.7281264.
Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton LJ 3rd. Risk factors for deep
vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med. 2000;
: 809–15. doi: 10.1001/archinte.160.6.809. PMID: 10737280.
Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of
venous thrombosis. JAMA. 2005; 293: 715–22. doi: 10.1001/jama.293.6.715. PMID: 15701913.
Hansson PO, Sorbo J, Eriksson H. Recurrent venous thromboembolism after deep vein thrombosis:
Incidence and risk factors. Arch Intern Med. 2000; 160: 769–74. doi: 10.1001/archinte.160.6.769. PMID:
Heit JA, Mohr DN, Silverstein MD, Petterson TM, O'Fallon WM, Melton LJ 3rd. Predictors of recurrence
after deep vein thrombosis and pulmonary embolism: A population-based cohort study. Arch Intern Med.
; 160: 761–68. doi: 10.1001/archinte.160.6.761. PMID: 10737275.
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.