Thromboembolic risk in repatriated patients with traumatic lower-limb injuries

Abstract

Venous thromboembolism (VTE) is a public health problem. Medical repatriation of patients with traumatic lower-limb injuries is common. There are no specific recommendations for the prevention of deep vein thrombosis (DVT). The main objective was to determine the incidence of VTE in this high-risk population and to determine associated risk factors. This was a prospective study including patients repatriated to France following lower-limb trauma and hospital discharge. A physical examination and a venous ultrasound were systematically performed on arrival. Reasons for repatriation, methods of VTE prevention and risk factors for VTE were studied. The positive diagnosis of deep venous thrombosis (DVT) was done by Doppler ultrasound. Fifty-two patients with lower-limb trauma were included. Six cases of DVT, four asymptomatic and two symptomatic with pulmonary embolisms were diagnosed. Two patients with asymptomatic DVT did not have preventive anticoagulation. No patient with preventive anticoagulation had symptomatic DVT. Smoking and the absence of preventive anticoagulation were significant risk factors for VTE. Repatriation of patients with lower-limb trauma in discharge is associated with an increased risk of VTE. Preventive anticoagulation appears to be effective in preventing DVT. Systematic Doppler imaging can reveal asymptomatic DVT. Our study did not evaluate specifically the interest of venous compression associated to preventive anticoagulation for VTE prevention. Specific recommendations on VTE prevention during repatriation of patients with lower-limb trauma are needed. Preventive anticoagulation should be systematically discussed during repatriation of patients with lower-limb trauma, in the absence of major bleeding risk. Due to the existence of asymptomatic DVT, venous Doppler ultrasound should also be systematically discussed despite the absence of official recommendations.