Choufani C, Aguir S, Barbier O
Service de chirurgie orthopédique, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
Service de chirurgie thoracique et vasculaire, HIA Percy, 1, rue du Lieutenant-Raoul-Batany, 92190 Clamart, France.
J Med Vasc. 2018 Dec;43(6):342-346. doi: 10.1016/j.jdmv.2018.10.005. Epub 2018 Oct 30.
Venous thromboembolism (VTE) is a public health problem. Medical repatriation of patients with traumatic lower-limb injuries is common. There are no specific recommendations for the prevention of deep vein thrombosis (DVT). The main objective was to determine the incidence of VTE in this high-risk population and to determine associated risk factors.
This was a prospective study including patients repatriated to France following lower-limb trauma and hospital discharge. A physical examination and a venous ultrasound were systematically performed on arrival. Reasons for repatriation, methods of VTE prevention and risk factors for VTE were studied. The positive diagnosis of deep venous thrombosis (DVT) was done by Doppler ultrasound.
Fifty-two patients with lower-limb trauma were included. Six cases of DVT, four asymptomatic and two symptomatic with pulmonary embolisms were diagnosed. Two patients with asymptomatic DVT did not have preventive anticoagulation. No patient with preventive anticoagulation had symptomatic DVT. Smoking and the absence of preventive anticoagulation were significant risk factors for VTE.
Repatriation of patients with lower-limb trauma in discharge is associated with an increased risk of VTE. Preventive anticoagulation appears to be effective in preventing DVT. Systematic Doppler imaging can reveal asymptomatic DVT. Our study did not evaluate specifically the interest of venous compression associated to preventive anticoagulation for VTE prevention. Specific recommendations on VTE prevention during repatriation of patients with lower-limb trauma are needed.
Preventive anticoagulation should be systematically discussed during repatriation of patients with lower-limb trauma, in the absence of major bleeding risk. Due to the existence of asymptomatic DVT, venous Doppler ultrasound should also be systematically discussed despite the absence of official recommendations.
静脉血栓栓塞症（VTE）是一个公共卫生问题。下肢创伤患者的医疗遣返很常见。目前尚无预防深静脉血栓形成（DVT）的具体建议。主要目的是确定这一高危人群中VTE的发生率，并确定相关危险因素。
这是一项前瞻性研究，纳入下肢创伤后出院并被遣返回法国的患者。患者抵达后系统地进行体格检查和静脉超声检查。研究遣返原因、VTE预防方法及VTE危险因素。深静脉血栓形成（DVT）的阳性诊断通过多普勒超声进行。
纳入52例下肢创伤患者。诊断出6例DVT，其中4例无症状，2例有症状且伴有肺栓塞。2例无症状DVT患者未接受预防性抗凝治疗。接受预防性抗凝治疗的患者均无有症状的DVT。吸烟和未进行预防性抗凝治疗是VTE的重要危险因素。
下肢创伤出院患者的遣返与VTE风险增加相关。预防性抗凝似乎对预防DVT有效。系统性多普勒成像可发现无症状DVT。我们的研究未具体评估预防性抗凝联合静脉压迫对预防VTE的作用。需要针对下肢创伤患者遣返期间VTE预防的具体建议。
对于下肢创伤患者，在不存在大出血风险的情况下，遣返期间应系统地讨论预防性抗凝治疗。由于存在无症状DVT，尽管缺乏官方建议，也应系统地讨论静脉多普勒超声检查。
