DR.G.ARUN PRASAD
I YEAR MDS
MAHATMA GANDHI POST
GRADUATE INSTITUTE OF DENTAL SCIENCES
GUIDE
DR.K.SANKAR
INTRODUCTION
¾ Deep vein thrombosis (DVT)is formation of blood
clot(thrombus) within the deep veins of any parts of
the body. It is a form of thrombophlebitis.
¾ DVT occurs in 25% of all hospitalized patients.
of all hospitalized patients
¾ It occurs in more than 50% of patients undergoing
orthopedic surgical procedures (hip/knee
replacement)and in 10 to 40% of patients who
undergo abdominal/thoracic surgery.
CASE PRESENTATION
A 40yr old women presented with
C/o pain and swelling in Left lower
C/o pain and swelling in Left lower
Jaw and inability to open the mouth
fully for about 6 days.
H/o Trauma (self fall) 6 days before
/ ,
There was no H/o Loc, vomiting g
and bleeding from nose/ear.
¾ Duration of surgery
g y was about 45 minutes.
Contd…
¾ On the second post operative day patient developed
mild swelling in the left leg which on examination was
not tender but of pitting type.
not tender but of pitting type
¾ On the 5th day after surgery, swelling became painful
day after surgery swelling became painful
and reaches above the knee and Calf muscle
tenderness was elicited.
¾ Colour Duplex Doppler examination of both lower limbs –
venous study was performed.
¾ Report reveals normal Doppler
evaluation of the veins of right lower
limb and ilio femoro popliteal deep
venous thrombosis in left limb.
¾ Patient was referred to vascular surgery
P ti t f d t l
department of higher institute for
further management.
Discussion
¾ Deep vein thrombosis and its potential complication,
pulmonary embolism , is a major cause of morbidity
l b li i j f bidi
and mortality in hospitalized patients(25%).
¾ Any major surgery lasting longer than 30 minutes
under GA is significant risk factor for
DVT(orthopedic/thoracic / abdominal)
Risk factors
¾ Surgery
¾ Trauma
¾ Immobility, paresis
¾ Malignancy
¾ Increasing age
¾ Obesity
¾ Inherited/acquired hypercoagulability
¾ Pregnancy and postpartum period
¾ Previous DVT
P i DVT
Stratification of surgical patients
Stratification of surgical patients
according to DVT risk
¾ Low risk ‐ Age <40 years, no risk factors, minor surgery
¾ Moderate risk ‐
d i k Age (40-60) years/major surgery/risk
A ( ) / j / i k
factor present.
¾ High risk ‐
High risk Age >60years/age>40years+major
surgery+ risk factor present.
¾ Highest risk
Highest risk ‐ Age
Age >40years+major surgery and
40years+major surgery and
previous DVT/cancer/hypercoagulable
condition/major trauma/hip surgery/spinal
cord injury.
Prophylaxis methods
Mechanical methods
Graduated compression stocking
I t
Intermittent pneumatic compression
itt t ti i
venous foot pumps
Pharmacological methods
Antiplatelet agents(aspirin,dextran)
Antithrombotic agents(LDUH/LMWH)
g ( / )
Vitamin k antagonist(warfarin)
Synthetic pentasaccharide factor xa inhibitor
(fondaparinux)
Accp Guidelines for Prophylaxis
Accp Guidelines for Prophylaxis
¾ Low risk ‐‐‐ No specific prophylaxis; early and
aggressive mobilization.
¾ Moderate risk ‐‐‐ low‐dose UFH,(every 12 hr)/
LMWH(<3400U/day)/GCS or IPC
¾ High risk ‐‐‐ low dose UFH(every 8 hr)/
LMWH(>3400U/day) or IPC
¾ Highest risk ‐‐‐ LMWH(<3400( U/day),fondaparinux,
)
warfarin(INR,2.0-3.0) or IPC/GCS +
l
low‐dose UFH/LMWH
d UFH/LMWH
Review of relevant literature
In review of literature, there are very few reports of
DVT associated
i d with i h surgery off the h orall and
d
maxillofacial region. To the best of my knowledge
there are only two cases reported with DVT in oral and
maxillofacial surgery published in Japanese Journal of
oral and maxillofacial surgery. One was a case of DVT
after orthognathic surgery in 19 yr old girl and other
was a case of DVT after mandibular reconstruction
with vascularized iliac bone graft in 30 yr old man.
man
CONCLUSION
Oral and maxillofacial surgery is not free of the risk of
DVT hi h
DVT, which can cause fatal acute pulmonary
f l l
thromboembolism. Therefore we have to assess the
patient for the risk of thromboembolism and proper
prophylaxis have to be done to prevent DVT in
individual with risk.
THANK YOU