Role of Clinical Assessment and D-Dimer Assay in Evaluating DVT in High Risk Surgical Patients
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 3
Abstract
Background & objectives:Deep vein thrombosis (DVT) is a potentially dangerous condition that can lead to preventable morbidity and mortality. The true incidence of DVT is unknown in high risk surgical patients and may lead to high morbidity and mortality when allowed to progress. It is often difficult to diagnose due to nonspecific sign and symptoms.Though there are ample of studies about DVT in the west 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 on the basis of clinical assessment and D-dimer. Methods: A prospective study of Patients with high risk group for DVT without evidences of clinical thromobosis was carried out in the Department of General Surgery , A .N.Magadh medical college and hospital Gaya from August 2017 to july 2018. Total 90 patients with high and highest risk were included in the study . The patients who already had a proven DVT and the patients who were receiving thromboprophylaxis were excluded. All the high risk surgical patients according to wells criteria underwent D-Dimer assay on POD 7 or clinical evident of DVT on the same POD. All patients who were clinically evident for DVT and D-Dimer value ≥0.3mg/L underwent colour duplex scan study to see for evidence of DVT in the Department Of Radiodiagnosis A.N.Magadh medical college,Gaya. Results: In our study we found incidence of DVT 2 per 90 high risk patients. Study design had maximum 100% patients as abdominal cases . Total 40 (50%) cases were malignant and rest 50% were benign cases. None of the patient had past history of DVT or family history.Regarding illness most of patients 27.5% were suffering from intestinal obstruction followed by intestinal perforation 15% and 10% stomach tumor and like condition. All DVT proved cases had Wells score of ≥3 ( high risk group).Regarding D dimer concerned the patient who showed DVT have D dimer value ≥0.3mg/L. None of the patient developed pulmonary embolism. Interpretation & conclusions: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 western population. In our study we found 2.2% incidence of DVT in high risk surgical patients. Large studies from India are required to confirm our findings. None of the patient developed pulmonary embolism.
Authors and Affiliations
Dr. anupam ranjan, Dr sweta rani, Dr mahesh chaudhary
Keywords
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- EP ID EP554863
- DOI 10.9790/0853-1803063739.
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