Association of Mechanism of Injury With Risk for Venous Thromboembolism After Trauma

Karcutskie, Charles A.; Meizoso, Jonathan P.; Ray, Juliet J.; Horkan, Davis B.; Ruiz, Xiomara; Schulman, Carl I.; Namias, Nicholas; Proctor, Kenneth G.

doi:10.1001/jamasurg.2016.3116

Cited by 57 publications

(44 citation statements)

References 33 publications

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“…Patients with multisystem injuries and traumatic brain injuries (TBIs) are at high risk for VTE events. 6,17 Twothirds of VTEs identified on screening venous duplex ultrasonography are asymptomatic, 18 but these patients remain at increased risk for illness and death. This emphasizes the importance of routine, standardized VTE prophylaxis in patients with trauma.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism prophylaxis and the impact of a thrombosis service at a Canadian level 1 trauma centre

Engels

Thomas

Coates

et al. 2019

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Background: Venous thromboembolism (VTE) is a common and serious complication seen in patients with trauma. Guidelines recommend the routine use of pharmacologic prophylaxis; however, compliance rates vary widely. The aim of this study was to describe the clinical practice related to VTE prophylaxis in the first 24 hours after injury at our level 1 Canadian trauma centre and the impact of a thrombosis consultation service. Methods: We performed a retrospective review of the health records of adult patients with trauma admitted between Jan. 1, 2012, and June 30, 2013. The rate of VTE was ascertained. The use of an initial prophylactic regimen, potential contraindications to prophylaxis and involvement of the thrombosis service were determined. Results: A total of 633 patients were included, 459 men and 174 women with a mean age of 47.4 years. The mean Injury Severity Score was 15.8. The overall VTE rate was 2.8%. A total of 514 patients (81.2%) received VTE prophylaxis, mechanical in 302 (47.7%) and pharmacologic in 231 (36.5%) (19 patients received both types). The thrombosis service was involved in the care of 164 patients (25.9%). Patients seen by the thrombosis service were more likely to receive VTE prophylaxis than those not seen by the service (145 [88.4%] v. 369 [78.7%], p < 0.01). Conclusion: Compliance with VTE prophylaxis administration was suboptimal, and opportunities for improvement exist. The involvement of a thrombosis consultation service appears to improve compliance with VTE prophylaxis, and augmented use of this service may improve clinical outcomes. Contexte : La thromboembolie veineuse (TEV) est une complication grave et fréquente chez les patients vus en traumatologie. Les lignes directrices recommandent l'utilisation systématique d'une prophylaxie pharmacologique; par contre, les taux de conformité aux lignes directrices varient beaucoup. Le but de cette étude était de décrire la pratique clinique en matière de thromboprophylaxie dans notre centre de traumatologie canadien de niveau 1 au cours des 24 premières heures suivant un traumatisme et l'impact d'un service de prévention des thromboses.

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Section: Discussionmentioning

confidence: 99%

Venous thromboembolism prophylaxis and the impact of a thrombosis service at a Canadian level 1 trauma centre

Engels

Thomas

Coates

et al. 2019

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“…Trauma patients can have a prothrombotic tendency due to factors such as pelvic fracture, blood transfusions, tranexamic acid administration, and surgery [38]. While venous thromboembolism may also be seen in surgery, introducing a foreign body into a vessel lumen and restricting flow increases this risk [39]. Thrombosis and arterial dissection during endovascular procedures leading to vessel occlusion and the need for extremity amputation are also documented in the acute setting.…”

Section: Definitive Managementmentioning

confidence: 99%

Endovascular Solutions for Iliac and Lower Extremity Junctional Injuries

Faulconer

Russo

Davidson

et al. 2017

JEVTM

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Hemorrhage is the second leading cause of death in trauma and non-compressible torso hemorrhage is the leading cause of preventable death within this population. Vascular injuries to the pelvis and lower extremity junctional zone may be difficult to control with direct pressure and complex to approach with open surgery. Endovascular interventions such as balloon occlusion, stenting and embolization are potential alternatives or adjuncts to traditional open surgery in patients with blunt or penetrating vascular injuries to the pelvis. This review of the literature will outline contemporary endovascular management strategies for iliac and junctional zone injuries.

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“…Venous thromboembolism (VTE) is a common occurrence in trauma patients, with an estimated incidence of as high as 9% in the civilian literature and up to 28% in military combat casualties 1 2. The consequences of VTE are not inconsequential as pulmonary embolism (PE) represents the third leading cause of in-hospital deaths in trauma patients and is a leading cause of readmission 3.…”

Section: Introductionmentioning

confidence: 99%

Prediction of venous thromboembolism using clinical and serum biomarker data from a military cohort of trauma patients

et al. 2020

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IntroductionVenous thromboembolism (VTE) is a frequent complication of trauma associated with high mortality and morbidity. Clinicians lack appropriate tools for stratifying trauma patients for VTE, thus have yet to be able to predict when to intervene. We aimed to compare random forest (RF) and logistic regression (LR) predictive modelling for VTE using (1) clinical measures alone, (2) serum biomarkers alone and (3) clinical measures plus serum biomarkers.MethodsData were collected from 73 military casualties with at least one extremity wound and prospectively enrolled in an observational study between 2007 and 2012. Clinical and serum cytokine data were collected. Modelling was performed with RF and LR based on the presence or absence of deep vein thrombosis (DVT) and/or pulmonary embolism (PE). For comparison, LR was also performed on the final variables from the RF model. Sensitivity/specificity and area under the curve (AUC) were reported.ResultsOf the 73 patients (median Injury Severity Score=16), nine (12.3%) developed VTE, four (5.5%) with DVT, four (5.5%) with PE, and one (1.4%) with both DVT and PE. In all sets of predictive models, RF outperformed LR. The best RF model generated with clinical and serum biomarkers included five variables (interleukin-15, monokine induced by gamma, vascular endothelial growth factor, total blood products at resuscitation and presence of soft tissue injury) and had an AUC of 0.946, sensitivity of 0.992 and specificity of 0.838.ConclusionsVTE may be predicted by clinical and molecular biomarkers in trauma patients. This will allow the development of clinical decision support tools which can help inform the management of high-risk patients for VTE.

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Association of Mechanism of Injury With Risk for Venous Thromboembolism After Trauma

Abstract: Although rates of VTE are the same in patients who experienced blunt and penetrating trauma, the independent risk factors for VTE are different based on mechanism of injury. This finding should be a consideration when contemplating prophylactic treatment protocols.

Cited by 57 publications

References 33 publications

Venous thromboembolism prophylaxis and the impact of a thrombosis service at a Canadian level 1 trauma centre

Venous thromboembolism prophylaxis and the impact of a thrombosis service at a Canadian level 1 trauma centre

Endovascular Solutions for Iliac and Lower Extremity Junctional Injuries

Prediction of venous thromboembolism using clinical and serum biomarker data from a military cohort of trauma patients

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