Venous thromboembolic complications in wounded with combat-related extremity injuries: 616-005.6

Abstract

Summary. Aim: to investigate the incidence and characteristics of venous thromboembolism (VTE) in patients with combat-related extremity injuries. Materials and Methods. A total of 290 patients with combat injuries of the lower or/and upper extremities, which occurred from 4 to 58 days (mean 16.4 ± 8.7 days) prior to admission to the hospital were included in a prospective observational study. All participants in the study were male. The age of the patients ranged from 19 to 59 years, with the mean of 36.2 ± 9.3 years. All patients underwent a venous duplex ultrasound scan of the lower extremities. Hematology and blood chemistry were performed in all patients. Additionally, a screening coagulogram was conducted, comprising measurements of activated partial thromboplastin time, prothrombin time, international normalized ratio, and fibrinogen. Thromboelastogram was performed in 15 patients, while the D-dimer concentration was determined in 16 patients. Prior to hospital admission, the most commonly used anticoagulant was enoxaparin (in 27.1%); yet in 65.4% of cases, the type of anticoagulant therapy was unknown. During hospitalization, the majority of patients received nadroparin calcium (78.3%) and parnaparin sodium (65.1%). Results. The overall incidence of VTE was 23.9%. The thrombotic masses were identified in the deep veins of the lower extremities (65.7%), the femoral veins (23.5%), and the popliteal veins (10.8%). The mean age of patients with VTE was 37.6 ± 10.3 years, and without VTE it was 35.3 ± 8.6 years (p = 0.05). Among patients with VTE, 43% were aged 40 years and older, compared to only 32.2% of patients without VTE (p < 0.00001). Among patients with VTE, 35.3% had had undergone amputations, compared to 21.1% of patients without VTE (p=0.01). The incidence of VTE was 45% in patients with amputations and 25% in those without (p = 0.003). The relative risk (RR) of VTE in patients with amputations was 2.3 (95% confidence interval (CI)=1.3–3.9). The incidence of VTE in patients with lower limb amputations at the hip level was 4.1% (95% CI = 1.6–10.7). The incidence of VTE was higher in patients aged ≥ 40 years (40%), compared to 25.9% in patients younger than 40 years (p = 0.09). The incidence of VTE was 37.7% in patients with external fixation devices and 33.5% in those without (p = 0.5). The following differences in laboratory parameters were identified between patients with and without VTE: total protein — 58.0 ± 7.3 vs. 61.6 ± 7.4 g/L (p = 0.003), albumin — 30.2 ± 4.5 vs. 32.8 ± 4.6 g/L (p = 0.006), creatinine — 101.5 ± 79.7 vs. 83.1 ± 12.1 μmol/L (p = 0.002), urea — 7.0 ± 6.6 vs. 5.2 ± 1.5 mmol/L (p = 0.001), leukocyte count — (11.1 ± 4.9)×109/L vs. (9.2 ± 2.8)×109/L (p = 0.0009), neutrophils — (8.2 ± 4.7)×109/L vs. (6.4 ± 2.4)×109/L (p = 0.0002), hemoglobin — 98.3 ± 17.3 vs. 104.2 ± 16.6 g/L (p = 0.02). The mean duration of inpatient follow-up was 32.9 ± 23.1 days (from 2 to 127 days). At the follow-up venous ultrasound 43.4% of patients had recanalization, 8.5% — moderate recanalization, 10.4% — initial recanalization, 1.9% — positive dynamics, and 14.1% of patients had no change in thrombotic masses. In 16% of cases, ultrasound examinations were not repeated. Conclusion. The study demonstrates the high incidence of VTE in patients with combat-related extremity injuries. The thrombotic masses are typically localized in the veins of lower extremities. Amputation is the main risk factor for VTE. Further research is required on VTE in patients with combat-related injuries to evaluate the efficacy of different anticoagulant regimens.

For citation: Topolyanskaya S.V., Bubman L.I., Vasilyeva Yu.Yu., Golimbekova M.V., Melnikova K.D., Lytkina K.A., Melkonyan G.G. Venous thromboembolic complications in wounded with combat-related extremity injuries. Tromboz, gemostaz i reologiya. 2024;(3):28–38. (In Russ.).

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