Predictive Value Of D-dimer,MPV And TEG In Preoperative Deep Venous Thrombosis In Patients With Lower Limb Fractures

BackgroundDeep venous thrombosis(DVT)of lower extremity is one of the most common serious complications of fracture.Early diagnosis and treatment of DVT is important in clinic.Thromboelastography(TEG)is a dynamic monitoring method of coagulation process.It has good value in predicting thrombosis.The purpose of this study is to explore the diagnostic value of preoperative mean platelet volume(MPV),D-dimer and TEG in patients with single lower limb fracture for DVT,and to provide a good basis for the evaluation of DVT.ObjectiveMeasured and analyzed MPV,D-dimer and TEG in patients with single lower limb fracture who had formed DVT before operation.To explore the predictive value of combined diagnosis for DVT,and to provide a better basis for preoperative evaluation of DVT in lower limb fracture patients.MethodsA retrospective analysis was made on the inpatients with single lower limb fracture from October 2017 to December 2018.Collected the demographic data of patients,fracture-related data,blood test results and doppler ultrasonography results.SPSS 22.0 software was used for statistical analysis.Chi-square test was used for counting data,and t-test for measuring data.Receivers operating characteristic(ROC)curves were derived to determine the sensitivity,specificity and cut-off point of the test.Values of P< 0.05 were considered to be statistically significant.ResultsEighty patients were enrolled in the study.45 patients had DVT and 35 patients were without DVT before operation.There was no significant difference in sex,smoking history,history of hypertension and K value between the two groups(p>0.05).There were significant differences in age,MPV,D-dimer,FDP,R value,alpha angle and MA(p < 0.05).The maximum Yoden index of MPV,MA,alpha angle and R determined by ROC curve were 0.358,0.603,0.296 and 0.301,respectively.The corresponding diagnostic cutoff points were 9.35 fl,65.85 mm,70.5 deg and 5.7min.The sensitivity and specificity of MPV,MA,alpha angle and R values were obtained by cross table method.The sensitivity and specificity of combined diagnosis determined by ROC curve.The area under ROC curve,sensitivity and specificity of MA combined with MPV were 0.841,71.1 % and 88.6 % respectively and had good predictive value.ConclusionsOur study showed that:(1)There was significant difference in age between thrombotic group and non-thrombotic group(p< 0.05),DVT screening should be performed for elder patients after admission.(2)There were significant differences in MPV,D-dimer,FDP,MA,R value and alpha angle between the two groups(p< 0.05).MA has the highest diagnostic value,MPV,alpha angle and R value are lower,D-dimer and FDP can not be used as effective diagnostic methods.(3)In the combined diagnostic analysis,AUC was 0.841 when MA was combined with MPV,and the sensitivity and specificity were 71.1 % and 88.6 % respectively,which can provide a basis for further diagnosis of DVT by color doppler ultrasonography of lower extremity vessels.