Epidural placement does not result in an increased incidence of venous thromboembolism in combat-wounded patients

Abstract

Therapeutic study, level IV.

Evaluation of Military Use of Tranexamic Acid and Associated Thromboembolic Events

“…Our overall VTE rate of 15.6% is substantially higher than the CRASH-2 and MATTERs studies, which reported rates of VTE of 1.8% and 4.0%, respectively. However, our rate is similar to the incidence others have published for combat casualty studies where VTE was a central focus . The trauma patient is known to be at increased risk for VTE, and the combat trauma patient population subset is at even higher risk .…”

“…However, our rate is similar to the incidence others have published for combat casualty studies where VTE was a central focus. 12 The trauma patient is known to be at increased risk for VTE, 13,14 and the combat trauma patient population subset is at even higher risk. 15,16 In addition, our cohort was severely injured and required medical evacuation to the US, with prolonged periods of immobility.…”

Epidural Analgesia after Rib Fractures

“…13 We found an increase in the rate of DVT in patients who had epidurals placed and decreased mobility may contribute to increased DVT rate. Caruso et al 33 recently noted that the risk of venous thromboembolism was significantly higher if an epidural was placed in patients with gunshot wounds. In contrast, epidural catheter use lowers the risk of venous thromboembolism in patients with total knee and hip replacement.…”

Pain Management in Military Trauma

“…Although current evidence concerning battlefield use is limited, common combat wounds, namely traumatic amputations, are compatible with this technique. [21][22][23] Use of these advanced techniques requires the integration of appropriately trained personnel as part of the front line team. 24 Pain management, as part of trauma management, must be firmly embedded in warfare casualty management with responsible practitioners firmly established in using the process.…”