Dose-adjusted thrombosis prophylaxis in trauma surgery according to levelsof D-dimer

In 234 trauma surgery patients, thrombosis prophylaxis with Nadroparin-Calc ium low-molecular-weight heparin (LMWH) was adjusted according to levels of D-Dimer. Basic prophylaxis was 2850 IU per day. If D-Dimer concentrations rose above 2 mg/L after the fourth postoperative (p.o.) day, LMWH was admin istered twice a day. Color Doppler ultrasound was performed between the fif th and seventh p.o, days. Patients were divided into a high-risk (group 1: hip, femur, or knee replacement surgery, n = 102) and a moderate-risk group (group 2: other surgery of the knee, tibia, fibula, or foot, n = 132). Gro up 1 showed significantly higher D-Dimer levels than group 2 (p<0.001). Mea sure ment of D-Dimer on days 2 and 4 p.o. showed a sensitivity of 100% and a specificity of 72.8% in identifying patients at risk (i.e., D-Dimer>2 mg/ L after day 4 p.o.). The overall deep vein thrombosis (DVT) rate in group 1 was 3.9%, and the rate of proximal DVT was 1.96%. In group 2, one distal D VT (0.8%) occurred. The results show that D-Dimer is a useful marker to mon itor p.o. coagulation activation and to manage LMWH prophylaxis in trauma s urgery patients. (C) 2000 Elsevier Science Ltd. All rights reserved.