Clinical effectiveness of a pneumatic compression device combined with low-molecular-weight heparin for the prevention of deep vein thrombosis in trauma patients: A single-center retrospective cohort study

doi:10.5847/wjem.j.1920-8642.2022.040

Abstract

Abstract:

BACKGROUND: To investigate the clinical effectiveness of a pneumatic compression device (PCD) combined with low-molecular-weight heparin (LMWH) for the prevention and treatment of deep vein thrombosis (DVT) in trauma patients.

METHODS: This study retrospectively analyzed 286 patients with mild craniocerebral injury and clavicular fractures admitted to our department from January 2016 to February 2020. Patients treated with only LMWH served as the control group, and patients treated with a PCD combined with LMWH as the observation group. The incidence of DVT, postoperative changes in the visual analogue scale (VAS) score, and coagulation function were observed and compared between the two groups. Excluding the influence of other single factors, binary logistic regression analysis was used to evaluate the use of a PCD in the patient's postoperative coagulation function.

RESULTS: After excluding 34 patients who did not meet the inclusion criteria, 252 patients were were included. The incidence of DVT in the observation group was significantly lower than that in the control group (5.6% vs. 15.1%, χ²=4.605, P<0.05). The postoperative VAS scores of the two groups were lower than those before surgery (P<0.05). The coagulation function of the observation group was significantly higher than that of the control group, with a better combined anticoagulant effect (P<0.05). There were no significant differences between the two groups in preoperative or postoperative Glasgow Coma Scale scores, intraoperative blood loss, postoperative infection rate, or length of hospital stay (P>0.05). According to logistic regression analysis, the postoperative risk of DVT in patients who received LMWH alone was 1.764 times that of patients who received LMWH+PCD (P<0.05). The area under the receiver operating characteristic (AUROC) curve of partial thromboplastin time (APTT) and platelet (PLT) were greater than 0.5, indicating that they were the influence indicators of adding PCD to prevent DVT. Excluding the influence of other variables, LMWH+PCD effectively improved the coagulation function of patients.

CONCLUSIONS: Compared with LMWH alone, LMWH+PCD could improve blood rheology and coagulation function in patients with traumatic brain injury and clavicular fracture, reduce the incidence of DVT, shorten the length of hospital stay, and improve the clinical effectiveness of treatment.

Key words: Deep vein thrombosis, Pneumatic compression device, Low-molecular-weight heparin, Trauma, Logistic regression analysis

Peng-chao Guo, Nan Li, Hui-ming Zhong, Guang-feng Zhao. Clinical effectiveness of a pneumatic compression device combined with low-molecular-weight heparin for the prevention of deep vein thrombosis in trauma patients: A single-center retrospective cohort study[J]. World Journal of Emergency Medicine, 2022, 13(3): 189-195.

Figures/Tables 5

Figure 1.

Table 1.

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Table 2.

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Variables	Control group (n=126)	Observation group (n=126)	t/Z/χ²	P-value
Sex Female, n (%) Male, n (%)	59 (46.8)	72 (57.1)	0.910^a	0.340
Sex Female, n (%) Male, n (%)	67 (53.2)	54 (42.9)	0.910^a	0.340
Age, years, mean±SD	48.3±6.4	53.7±5.9	0.219^b	0.873
Hypertension, n	21 (16.7)	24 (19.1)	0.311^a	0.771
Diabetes, n	7 (5.6)	6 (4.8)	1.279^a	0.204
Antiplatelet therapy, n	13 (10.3)	14 (11.1)	0.584^a	0.445
Oral anticoagulant, n	15 (11.9)	11 (8.7)	0.727^a	0.469
Caprini risk scores, n High risk (3-4) Highest risk (≥5)	59 (46.8) 67 (53.2)	53 (42.1) 73 (57.9)	-0.759^a	0.448
Glasgow Coma Scale score, n 13 14 15	22 (17.5) 31 (24.6)	26 (20.6) 29 (23.1)	-0.408^c	0.684
Glasgow Coma Scale score, n 13 14 15	73 (57.9)	71 (56.3)	-0.408^c	0.684
Clavicle fracture type, n Mid fracture Acromion fracture	74 (58.7) 52 (41.3)	87 (69.1) 39 (30.9)	-1.702^a	0.089

Variables	β	S.E.	Wald	Sig.	OR	95% CI
Sex	0.505	0.463	1.189	0.276	1.657	0.669-4.106
Age	-0.016	0.015	1.075	0.300	0.984	0.955-1.014
Baseling disease	-0.117	0.555	0.045	0.833	0.889	0.300-2.638
Caprini risk score	0.017	0.088	0.039	0.844	1.017	0.856-1.210
Length of stay	0.121	0.082	2.189	0.139	1.129	0.961-1.325
GCS	0.156	0.279	0.314	0.576	1.169	0.676-2.021
Blood loss	0.006	0.017	0.130	0.719	1.006	0.973-1.041
Drugs	0.300	0.806	0.139	0.709	1.350	0.278-6.550
APTT	0.032	0.052	0.379	0.538	1.033	0.932-1.144
PLT	-0.016	0.010	2.785	0.095	0.984	0.965-1.003
PCD	1.764	0.598	8.701	0.003^*	5.833	1.807-18.828
Fracture type	-0.145	0.507	0.081	0.775	0.865	0.321-2.335

Variables	Cut-off	Sensitivity	Specificity	Youden Index	AUC (95% CI)	P-value
APTT	37.5 s	0.849	0.857	0.378	0.628 (0.407-0.849)	<0.05
Caprini risk score	6.5	0.454	0.286	0.168	0.520 (0.291-0.750)	0.257
Length of stay	7.5 d	0.429	0.286	0.143	0.466 (0.248-0.683)	0.602
GCS	13.5	0.647	0.857	-0.210	0.354 (0.156-0.552)	0.196
Blood loss	35.5 mL	0.387	0.286	0.101	0.441 (0.256-0.627)	0.076
Infection rate	38.85%	0.244	0.429	-0.185	0.297 (0.076-0.518)	0.072
PLT	124×10⁹/L	0.924	0.571	0.353	0.700 (0.495-0.904)	<0.05

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