Article

The practice of venous thromboembolism prophylaxis in the major trauma patient

Department of Surgery, University of Toronto, Toronto, Ontario, Canada
The Journal of trauma (Impact Factor: 2.96). 03/2007; 62(3):557-62; discussion 562-3. DOI: 10.1097/TA.0b013e318031b5f5
Source: PubMed

ABSTRACT The incidence of venous thromboembolism (VTE) without prophylaxis is as high as 80% after major trauma. Initiation of prophylaxis is often delayed because of concerns of injury-associated bleeding. As the effect of delays in the initiation of prophylaxis on VTE rates is unknown, we set out to evaluate the relationship between late initiation of prophylaxis and VTE.
Data were derived from a multicenter prospective cohort study evaluating clinical outcomes in adults with hemorrhagic shock after injury. Analyses were limited to patients with an Intensive Care Unit length of stay >or=7 days. The rate of VTE was estimated as a function of the time to initiation of pharmacologic prophylaxis. A multivariate stepwise logistic regression model was used to evaluate factors associated with late initiation.
There were 315 subjects who met inclusion criteria; 34 patients (11%) experienced a VTE within the first 28 days. Prophylaxis was initiated within 48 hours of injury in 25% of patients, and another one-quarter had no prophylaxis for at least 7 days after injury. Early prophylaxis was associated with a 5% risk of VTE, whereas delay beyond 4 days was associated with three times that risk (risk ratio, 3.0, 95% CI [1.4-6.5]). Factors associated with late (>4 days) initiation of prophylaxis included severe head injury, absence of comorbidities, and massive transfusion, whereas the presence of a severe lower extremity fracture was associated with early prophylaxis.
Clinicians are reticent to begin timely VTE prophylaxis in critically injured patients. Patients are without VTE prophylaxis for half of all days within the first week of admission and this delay in the initiation of prophylaxis is associated with a threefold greater risk of VTE. The relative risks and benefits of early VTE prophylaxis need to be defined to better direct practice in this high-risk population.

1 Follower
 · 
234 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Study Design. Retrospective cohort study Objective. To examine the impact of early (<48 hours) versus late (>=48 hours) initiation of pharmacologic venous thromboembolism (VTE) prophylaxis on outcomes and complications among trauma patients undergoing operative fixation of spine fractures Summary of Background Data. VTE complications are associated with poor outcomes following trauma. Although pharmacologic prophylaxis decreases the risk of VTE following trauma, concerns regarding bleeding-related complications among certain patient subgroups persist. At present, there are limited data regarding the safety of early VTE prophylaxis in trauma patients undergoing operative fixation of spine fractures. Methods. We performed a 5-year retrospective analysis of our level 1 trauma center registry to identify consecutive patients undergoing operative fixation of spine fractures. Demographics, injury patterns and severity, details of operative procedures, timing of administration of VTE prophylaxis, and outcomes were analyzed. Patients receiving early VTE prophylaxis were compared to patients receiving late VTE prophylaxis. Multivariate analysis was performed to identify independent predictors of VTE. Results. Of 1,432 patients with spine fractures, 206 patients (14.4%) underwent operative fixation. Forty-eight (23.3%) received early VTE prophylaxis and 158 (76.7%) received late VTE prophylaxis. No patient developed an epidural hematoma or postoperative bleeding necessitating intervention in either group. Thirteen patients (6.2%) developed VTE, of which 12 occurred in the late VTE prophylaxis group. Age >=45 (OR = 5.12, 95% CI = 1.01-25.94, p = 0.048) and TBI (OR = 6.94, 95% CI = 1.19-40.35, p = 0.031) were independently associated with an increased risk for VTE. Conclusions. Pharmacologic VTE prophylaxis initiated within 48 hours of operative fixation of traumatic spine fractures appears to be safe and is not associated with an increased risk of bleeding or neurological complications. Large, multicenter prospective studies are required to further define the efficacy and safety of an early pharmacologic VTE prophylaxis strategy in this at-risk patient population. Copyright
    Spine 01/2014; DOI:10.1097/BRS.0000000000000754 · 2.45 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute traumatic coagulopathy develops in seriously injured patients, which is followed by a paradoxical hypercoagulable state. The hypercoagulable state contributes to venous thromboembolism, and yet, there are no sensitive tests available to detect it. The aim of this study was to characterize the hypercoagulable state caused by major orthopedic trauma using the overall hemostatic potential (OHP) assay.
    Journal of Trauma and Acute Care Surgery 08/2014; 77(2):231-237. DOI:10.1097/TA.0000000000000311 · 1.97 Impact Factor
  • Article: Response.
    Chest 01/2014; 145(1):195-6. DOI:10.1378/chest.13-2329 · 7.13 Impact Factor

Full-text (2 Sources)

Download
126 Downloads
Available from
May 30, 2014