Plasma D-dimer in the prediction of deep vein thrombosis after the fracture in the school-age children

LIU Yong-li; CHENG Fu-li; JING Xiao-bo; WANG Lai-xi; SHEN Zi-long

doi:10.3969/j.issn.2095-252X.2017.07.010

Abstract：Objective To determine the incidence and mechanism of deep vein thrombosis ( DVT ) in the school-age children, and to propose the prevention and treatment measures. Methods A total of 1367 cases of 4 years or older children underwent the treatment for fractures of lower limbs from January 2013 to June 2016. There were 26 cases of pelvic fractures, 811 cases of femur the ( including femoral neck, femoral spine, femoral condyle ), 376 cases of lower leg fractures, and 154 cases of foot fractures. The children were at the ages ranging from 4 years to 14 years and 5 months, with the average age 10 years and 10 months. After the children were admitted to the hospital, a regular blood test and the detection of plasma D-dimer levels and the deep venous color doppler ultrasonography were performed. Anticoagulatory thrombolytic therapy was performed for children with deep vein thrombosis. The main treatment methods included subcutaneous injection of low molecular weight heparin calcium and oral traditional Chinese medicine decoction. The plasma D-dimer levels and color Doppler ultrasound were monitored and treatment persisted for 2 - 4 weeks. If the plasma D-dimer levels were greater than 500 μg / L, deep vein ultrasonography of Double lower limb was performed, if no clots were found, no anticoagulants were given, and monitoring was given by regular plasma D-dimer levels and the deep venous color doppler ultrasonography until the plasma D-dimer levels droped to below 500 μg / L. Results D-dimer levels of 127 patients were over 500 μg / L. Six cases had deep vein thrombosis confirmed by Doppler ultrasonography, including three femoral fractures, one femoral condyle fracture, and one femoral fracture with fracture of the femur. The thrombus was located in the popliteal vein and / or the posterior tibial vein, after 2 - 4 weeks of anticoagulation / thrombolytic therapy, the clot disappeared, and the blood clots were not seen again. Conclusions Deep vein thrombosis is rare in children after fracture, but there are still risks for thrombosis. Preoperative screening active anticoagulation and essential. Preventing the clot from falling is very important since are falling of clot may cause pulmonary embolism, which can even be life-threatening. Dynamic plasma D-dimer monitoring is critical to the timely diagnosis of DVT for early diagnosis and treatment.