Deep vein thrombosis in elderly patients

Background and objective: There are only a few data on the circumstances and incidence of deep vein thrombosis (DVT) in the elderly, although they are generally considered at risk of it. Classical signs of DVT are atypical or not present. Isolated leg swelling also frequently occurs postoperatively or in the course of a cerebrovascular accident. In this prospective study patient characteristics and associated circumstances pointing to the risk of DVT or an existing DVT were systematically investigated. This was to facilitate rational refferal for further tests. Patients and methods: From March 1999 for a total of 13 weeks all new admissions to the specialist geriatric clinic Bad Salzdetfurth, 101 women and 46 men (48-49 years, average 76.6 years) underwent thrombosis screening with duplex sonography of both legs within the first 24 hours after admission. In addition the results of laboratory tests, ECG and medical-geriatric examinations were evaluated and age, sex, duration of stay at an acute hospital, main and subsidiary diagnosis, Barthel index and current medication were recorded. Results: 35 not previously diagnosed DVT were found in 30 of the 101 patients. Independent variables that were significantly more frequent associated with DVT were previous long hospital stay, female sex and higher heart rate in the admission ECG. Neither main and additional diagnosis, age, previous medication, Barthel index, haemoglobin concentration, previous thrombosis nor previous stress on a not yet stable fracture and previous clinical suspicion of DVT were statistically significant risk factors for DVT. Conclusions:, Purely clinical investigation is not suitable for confirming or excluding DVT in elderly patients. It was possible to define a constellation of risks for DVT by combining data from previous examinations with those of routine medical diagnosis.