Prophylaxis practice and incidence of deep vein thrombosis among patients operated for hip fracture at Muhimbili orthopaedic institute, Dar es salaam

Abstract

Deep vein thrombosis is clot formed within the deep veins of the lower limbs or pelvis where it causes pain and swelling. When some or all of thrombus becomes detached and moves retrograde in the right side of the heart and lodge in one or more pulmonary arteries, pulmonary embolism occurs. Massive pulmonary embolism is fatal to life. Hip fracture and major lower injuries are risk factor for deep vein thrombosis. DVT prophylaxis is therefore important to hip fracture patients. This was a facility based descriptive study which was conducted at MOI in DSM city from 2016-May to June 2017. The objective of the study was to determine the prophylaxis practice and incidence of DVT among patients operated for hip fracture at MOI. Patients who sustained hip fracture and those who fulfilled the desired criteria for this study were selected by convenient non random sampling and enrolled day after their surgical treatment of the fracture. A structured questionnaire was used in capturing baseline information of the patients including, name, age, mechanism of injury, immobilization duration before and after surgery, co morbid conditions, the type of DVT prophylaxis given and any associated clinical signs and symptoms suggestive of DVT. Each patient was followed up for a minimum of 4 weeks from the day of discharge. During the follow visits clinical progress was assessed including evaluations of clinical signs and symptoms of DVT such limb swelling, redness, pain and tenderness. The informed obtained were entered in the research tools, processed and analyzed using SPSS computer software version 20. The study results indicated comparatively low (23%) rate of DVT prophylaxis practice among 49 enrolled cases. And incidence of the DVT is also lower (6%) of the study group. Chemical prophylaxis was the commonest prophylactic agent used followed by emphasis on early ambulation after operation. Mechanical prophylaxis such as graduated compression stocking and intermittent pneumatic compression were rarely used. The emphasis should be put on screening of all patients at risk of DVT and provide DVT prophylaxis to all eligible patients. Further study is needed to establish the fundamental differences in rate and incidence of DVT observed in different racial groups.