Abstract
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are known collectively as venous thromboembolism (VTE). Venous thromboembolic events are common and potentially life-threatening complications following trauma with an incidence of 5 to 63%. DVT prophylaxis is essential in the management of trauma patients. Currently, the optimal VTE prophylaxis strategy for trauma patients is unknown. Traditionally, pelvic and lower extremity fractures, head injury, and prolonged immobilization have been considered risk factors for VTE; however it is unclear which combination of risk factors defines a high-risk group. Modalities available for trauma patient thromboprophylaxis are classified into pharmacologic anticoagulation, mechanical prophylaxis, and inferior vena cava (IVC) filters. The available pharmacologic agents include low-dose heparin (LDH), low molecular weight heparin (LMWH), and factor Xa inhibitors. Mechanical prophylaxis methods include graduated compression stockings (GCSs), pneumatic compression devices (PCDs), and A-V foot pumps. IVCs are traditionally used in high risk patients in whom pharmacological prophylaxis is contraindicated. Both EAST and ACCP guidelines recommend primary use of LMWHs in trauma patients; however there are still controversies regarding the definitive VTE prophylaxis in trauma patients. Large randomized prospective clinical studies would be required to provide level I evidence to define the optimal VTE prophylaxis in trauma patients.
Highlights
Deep vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), affect an estimated 900,000 people in the U.S each year resulting in several hundred thousand hospitalizations and about 300,000 deaths [1]
If there is a contraindication for low molecular weight heparin (LMWH), mechanical thromboprophylaxis with pneumatic compression devices (PCDs) or possibly with graduated compression stockings (GCSs)
Despite the fact that none of the methods of the prophylaxis provide complete prevention from VTE, it is clear that without prophylaxis the incidence of occult and nonoccult DVT would be higher with the potential for increased risk of VTE-related morbidity and mortality
Summary
Deep vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), affect an estimated 900,000 people in the U.S each year resulting in several hundred thousand hospitalizations and about 300,000 deaths [1]. In general surgical patients without prophylaxis against VTE, the incidence of DVT has been reported to be as high as 30%, with an associated fatality risk of 1% [4]. The incidence of DVT varies from 5 to 63% in trauma patients depending on patient’s risk factors, modality of prophylaxis, and methods of detection [13, 14]. A general population study that followed 21,680 persons for occurrence of venous thrombosis over 7.6 years demonstrated that trauma was only present in 6%, revealing a relatively low potential number of cases globally that could be avoided with prophylaxis in this setting, while cancer was present in 48% and surgery was present in 42% [14]. Specific search terms used included DVT, risk factors, trauma, guidelines, and prophylaxis
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