Department of Pharmacy, Tianjin Hospital, Tianjin 300211, China.
Department of Vascular Surgery, Tianjin Hospital, Tianjin 300211, China.
Injury. 2024 Aug;55(8):111710. doi: 10.1016/j.injury.2024.111710. Epub 2024 Jun 26.
Deep vein thrombosis (DVT) provoked by orthopedic trauma is increasing in pediatric hospitalized patients. The purpose of our study is to identify the prevalence of acute DVT in pediatric and adolescent orthopedic trauma hospitalized patients and focus on evaluating the anticoagulation strategies and the clinical outcomes after a confirmed acute DVT.
Patients (age ≤18 years) with a confirmed acute DVT admitted for orthopedic trauma between September 2017 and December 2023 were included. Patients were classified into the non-anticoagulation (NA), the in-hospital anticoagulation (IHA), and the in-and-out-of-hospital anticoagulation (IOHA) groups based on their anticoagulation regimen. Efficacy outcomes were the venous thromboembolism (VTE) recurrence within 3 months and change in thrombus burden by repeat imaging at 2 weeks after discharge compared with baseline. Safety outcomes were major bleeding (MB) and clinically relevant non-major bleeding (CRNMB) within 3 months.
Of the 11,206 pediatric and adolescent orthopedic trauma inpatients, 94(median age,16 [15, 18] years) were diagnosed with acute DVT, with an incidence of 0.84 %, of which 8(8.5 %) received NA, 41(43.6 %) received IHA, and 45(47.9 %) received IOHA. After the diagnosis of DVT, of patients who received anticoagulation, 97.9 % were treated with rivaroxaban as an oral anticoagulant, and 71.7 % received an LMWH course of ≥5 days before starting rivaroxaban therapy. With a median anticoagulation course of 22(8, 37.3) days, the duration in the IOHA was significantly longer than the IHA (37 days vs. 8 days, p = 0.000). No patients experienced recurrent VTE and MB at 3 months, and 1 received IOHA had a CRNMB event (0 % vs. 0 % vs. 2.2 %, p = 1.000). Thrombus resolution was significantly higher in patients who received anticoagulation therapy (IOHA 91.1 % vs. IHA 80.5 % vs. NA 37.5 %, P = 0.002), and thrombus-no relevant change was significantly lower in patients who received the IOHA strategy compared with the other groups (4.4 % vs. 19.5 % vs. 62.5 %, P = 0.000).
A rivaroxaban-predominant IOHA strategy significantly reduced the thrombotic burden without increasing the risk of bleeding for the treatment of DVT in adolescents with orthopedic trauma. Duration of anticoagulation therapy <6 weeks appears appropriate for adolescent orthopedic trauma-related DVT.
骨科创伤导致的深静脉血栓（DVT）在儿科住院患者中日益增多。本研究旨在确定儿科和青少年骨科创伤住院患者中急性 DVT 的患病率，并重点评估确诊急性 DVT 后的抗凝策略和临床结局。
纳入 2017 年 9 月至 2023 年 12 月期间因骨科创伤住院并确诊为急性 DVT 的患者（年龄≤18 岁）。根据抗凝方案，将患者分为非抗凝（NA）、院内抗凝（IHA）和院内外抗凝（IOHA）组。疗效终点为 3 个月内静脉血栓栓塞症（VTE）复发和与基线相比，出院后 2 周重复影像学检查时血栓负担的变化。安全性终点为 3 个月内主要出血（MB）和临床相关非主要出血（CRNMB）。
在 11206 例儿科和青少年骨科创伤住院患者中，94 例（中位年龄 16 [15，18] 岁）诊断为急性 DVT，发病率为 0.84%，其中 8 例（8.5%）接受 NA，41 例（43.6%）接受 IHA，45 例（47.9%）接受 IOHA。在 DVT 确诊后，接受抗凝治疗的患者中，97.9%接受利伐沙班作为口服抗凝剂治疗，71.7%在开始利伐沙班治疗前接受至少 5 天的低分子肝素治疗。抗凝疗程中位数为 22（8，37.3）天，IOHA 的疗程明显长于 IHA（37 天比 8 天，p=0.000）。在 3 个月时，无患者发生复发性 VTE 和 MB，1 例接受 IOHA 的患者发生 CRNMB 事件（0%比 0%比 2.2%，p=1.000）。接受抗凝治疗的患者血栓溶解率明显更高（IOHA 91.1%比 IHA 80.5%比 NA 37.5%，P=0.002），IOHA 策略组与其他组相比，血栓无明显变化的比例明显更低（4.4%比 19.5%比 62.5%，P=0.000）。
利伐沙班为主的 IOHA 策略可显著降低青少年骨科创伤相关 DVT 的血栓负荷，同时不增加出血风险。6 周内的抗凝治疗疗程似乎适用于青少年骨科创伤相关 DVT。
