Abstract
PurposeVenous thromboembolisms (VTE) are a major concern after acute survival from trauma. Variations in treatment protocols for trauma patients exist worldwide. This study analyzes the differences in the number of VTE events and the associated complications of thromboprophylaxis between two level I trauma populations utilizing varying treatment protocols.MethodsInternational multicenter trauma registry-based study was performed at the University Medical Center Utrecht (UMCU) in The Netherlands (early commencement chemical prophylaxis), and Harborview Medical Center (HMC) in the United States (restrictive early chemical prophylaxis). All severely injured patients (ISS ≥ 16), aged ≥ 18 years, and admitted in 2013 were included. Primary outcomes were VTE [deep venous thrombosis (DVT) (no screening), pulmonary embolism (PE)], and hemorrhagic complications.ResultsIn UMCU, 279 patients were included and in HMC, 974 patients. Overall, 75% of the admitted trauma patients in UMCU and 81% in HMC (p < 0.001) received thromboprophylaxis, of which 100% in and 75% at, respectively, UMCU and HMC consisted of chemical prophylaxis. From these patients, 72% at UMCU and 47% at HMC (p < 0.001) were treated within 48 h after arrival. At UMCU, 4 patients (1.4%) (PE = 3, DVT = 1) and HMC 37 patients (3.8%) (PE = 22, DVT = 16; p = 0.06) developed a VTE. At UMCU, a greater percent of patients with VTE had traumatic brain injuries (TBI). Most VTE occurred despite adequate prophylaxis being given (75% UMCU and 81% HMC). Hemorrhagic complications occurred in, respectively, 4 (1.4%) and 10 (1%) patients in UMCU and HMC (p = 0.570). After adjustment for age, ISS, HLOS, and injury type, no significant difference was demonstrated in UMCU compared to HMC for the development of VTE, OR 2.397, p = 0.102 and hemorrhagic complications, OR 0. 586, p = 0.383.ConclusionsA more early commencement protocol resulted in almost twice as much chemical prophylaxis being started within the first 48 h in comparison with a more delayed initiation of treatment. Interestingly, most episodes of VTE developed while receiving recommended prophylaxis. Early chemical thromboprophylaxis did not significantly increase the bleeding complications and it appears to be safe to start early.
Highlights
Trauma is one of the leading causes of death and disability in every country of the world [1]
At University Medical Center Utrecht (UMCU), 75% of patients received some form of thromboprophylaxis during their admission compared to 81% at Harborview Medical Center (HMC) (p ≤ 0.001)
At HMC, 75% of the patients were treated with chemical prophylaxis, 12% were treated with a vena cava filter (VCF) of which 3% were treated with both chemical prophylaxis and a VCF
Summary
Trauma is one of the leading causes of death and disability in every country of the world [1]. After the survival after the acute phase on the first day, the greatest concerns in these patients are life-threatening complications, such as venous thromboembolism (VTE) [2,3,4,5]. Pulmonary embolism is the third leading cause of death in trauma patients surviving the first day [3, 4], in the severely injured patient [3, 5, 6]. Without prophylaxis, hospitalized patients following major trauma have a great risk of developing VTE [7, 9,10,11,12]. The increased risk of venous thrombosis in these patients is classically caused by endothelial injury, stasis of blood flow, and high intrinsic hypercoagulability, known as Virchow’s Triad [13, 14]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
