Abstract
Deep venous thrombosis prophylaxis is essential to the appropriate management of multisystem trauma patients. Without thromboprophylaxis, the rate of venous thrombosis and subsequent pulmonary embolism is substantial. Three prophylactic modalities are common: pharmacologic anticoagulation, mechanical compression devices, and inferior vena cava filtration. A systematic review was completed using PRISMA guidelines to evaluate the potential complications of DVT prophylactic options. Level one evidence currently supports the use of low molecular weight heparins for thromboprophylaxis in the trauma patient. Unfortunately, multiple techniques are not infrequently required for complex multisystem trauma patients. Each modality has potential complications. The risks of heparin include bleeding and heparin induced thrombocytopenia. Mechanical compression devices can result in local soft tissue injury, bleeding and patient non-compliance. Inferior vena cava filters migrate, cause inferior vena cava occlusion, and penetrate the vessel wall. While the use of these techniques can be life saving, they must be appropriately utilized.
Highlights
Multisystem traumatic injury is a significant risk factor for the development of a deep venous thrombosis (DVT)
Mechanical compression device thromboprophylaxis should not be used as an initial choice, evidence supports its role in trauma patients when LMWHs are contraindicated
When LMWH and mechanical device thromboprophylaxis are contraindicated, retrievable inferior vena cava (IVC) filters should be considered in high-risk trauma patients [79]
Summary
Multisystem traumatic injury is a significant risk factor for the development of a deep venous thrombosis (DVT). Overall DVT rates exceed 50% [1,2,3]. DVT alone is not life-threatening, a resulting pulmonary embolism (PE) carries potentially significant morbidity and mortality. Trauma patients at the highest risk have been identified as those with a lower extremity or pelvic fracture, spinal cord injury, brain injury (Glasgow Coma Score < 8), increased age, surgical intervention, femoral central venous catheter, and prolonged immobilization [2,3,7,8,9]. Modalities available for trauma patient thromboprophylaxis are classified into pharmacologic anticoagulation, mechanical compression devices, and inferior vena cava (IVC) filtration. The options are numerous, level one evidence currently supports the use of pharmacologic anticoagulation with low molecular
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