Evaluation of Appropriate Venous Thromboembolism Prophylaxis in Patients With Orthopaedic Trauma With Symptom-Driven Vascular and Radiographic Studies

Domes, Christopher M.; Schleyer, Anneliese M.; McQueen, James M.; Pergamit, Ronald; Beingessner, Daphne M.

doi:10.1097/bot.0000000000000991

“…[25][26][27][28][29] The orthopedic trauma literature has detailed the relatively higher risk of VTE among orthopedic trauma patients with pelvic fracture or femur fracture. 30,31 This disproportionately higher thrombotic morbidity is also well described in the trauma literature, specifically with obesity, lower extremity fractures, and TBI itself significantly increasing risk of thrombotic events. 28,32 Although we failed to detect an interaction of VTE-CHEMO timing and VTE incidence in these high-risk subgroups, this may be because of the small number of patients with these risk factors in our study.…”

Section: Discussionmentioning

confidence: 82%

A Stitch in Time Saves Clots: Venous Thromboembolism Chemoprophylaxis in Traumatic Brain Injury

Coleman

¹

,

Carmichael

²

,

Zangara

³

et al. 2021

Journal of Surgical Research

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“…② Feng's spinal manipulation could restore the dislocated and disordered joints to the normal physical locations by promoting the movements of these joints and spasmodic muscles, which could effectively relieve joint incarceration and improve lumbar dysfunction. ③ The manipulation also helped to reopen the soft tissue (such as adhesive ligaments and muscles) and restore the muscle elasticity besides promoting the movements of bones and joints [ 23 , 24 ]. The straight leg raising test, as a common examining method, could reflect the severity of sciatica and LDH and the compression of nerve root [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Curative Effects of Remote Home Management Combined with Feng’s Spinal Manipulation on the Treatment of Elderly Patients with Lumbar Disc Herniation

Min

¹

,

Xu²

2022

Journal of Healthcare Engineering

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Objective. To explore the curative effects of remote home management combined with Feng’s spinal manipulation on the treatment of elderly patients with lumbar disc herniation (LDH). Methods. The clinical data of 100 patients with LDH in our hospital (December 2019–December 2020) were retrospectively reviewed. The 100 patients were equally divided into a routine treatment group and interventional group according to the order of admission. The routine treatment group received conventional rehabilitation training, and the interventional group received remote home management combined with Feng’s spinal manipulation. The Oswestry disability index (ODI) and straight leg raising test were adopted for the assessment of the degrees of dysfunction and straight leg raising angles of the two groups after intervention. The curative effects of the two rehabilitation programs were evaluated. Results. Compared with the routine treatment group, the interventional group had a remarkably higher excellent and good rate P < 0.05 , a significantly lower average ODI score after intervention P < 0.001 , notably higher straight leg raising angle, surface AEMG (average electromyogram) during stretching and tenderness threshold after intervention P < 0.001 , markedly lower muscular tension, surface AEMG during buckling, and flexion-extension relaxation ratio (FRR; P < 0.001 ), and much higher quality of life scores after intervention P < 0.001 . Conclusion. The remote home management combined with Feng’s spinal manipulation, as a reliable method to improve the quality of life and the back muscular strength of the elderly patients with LDH, can substantially increase the straight leg raising angle and reduce the degree of dysfunction. Further study is conducive to establishing a better solution for the patients with LDH.

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“…Rationale: Orthopaedic trauma patients frequently have concomitant visceral and/or brain injuries 26-29 . In general, major fractures significantly increase the risk of VTE in polytrauma 30-35 while non-orthopaedic injuries (except spinal cord injuries) generally have a much lower impact on the risk of VTE associated with fractures 36,37 . Conversely, bleeding risk in patients with polytrauma is largely dictated by the presence of visceral and brain injuries.…”

Section: - What Is the Optimal Vte Prophylaxis For Polytrauma Patient...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Trauma

2022

Journal of Bone and Joint Surgery

13

0

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The ICM-VTE Trauma Delegates* 1 -What is the most optimal VTE prophylaxis in patients with multiple orthopaedic injuries?Response/Recommendation: Although multiple forms of prophylaxis against venous thromboembolism (VTE) with variable effectiveness are available for patients with multiple orthopedic injuries, low-molecular-weight heparin (LMWH) is considered the most optimal choice based on available literature.Strength of Recommendation: Acceptable.Delegates vote: Agree 86.36% Disagree 9.09% Abstain 4.55% (Strong Consensus).Rationale: VTE events following multiple orthopaedic injuries are associated with significant morbidity and mortality 1,2 . The prevalence of deep venous thrombosis (DVT) in trauma patients without prophylactic treatment can reach up to 60%. Pulmonary embolism (PE) can be a fatal form of VTE with prevalence ranging between 2 -16% 3,4 . VTE can be prevented using different mechanical and chemical prophylaxis agents, therefore, significantly lower the burden on healthcare systems worldwide 1 . The aim of this review is to find the most optimal VTE prophylaxis in patients with multiple orthopaedic injuries.Multiple orthopaedic injuries rarely happen without extraskeletal injuries, therefore, no studies in the current literature addressed VTE prophylaxis in patients with multiple orthopaedic injuries but without extra-skeletal injuries. Most of the available literature is addressing this patient population under different groups including, patients with trauma, poly-trauma, high energy fractures and lower extremity injuries [1][2][3][5][6][7] . The level of evidence varies among the reviewed literature, however, randomized controlled clinical trials in this subject are limited 3,4 .Based on our review, LMWH is considered the most optimal VTE prophylaxis in patients with multiple orthopaedic injuries 1,3,5,6,[8][9][10][11][12][13][14] . Ley et al., recommends using LMWH due to its increased bioavailability, acceptably low bleeding complications and longer plasma half-life 1 . Rogers et al., published in their guidelines for prevention of VTE in trauma patients that LMWH has superior bioavailability when compared to lowdose heparin (LDH) 5 . Knudson et al., concluded in a prospective, randomized trial that LMWH is an extremely effective *A list of the ICM-VTE Trauma Delegates is included in a note at the end of the article. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G855).

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Evaluation of Appropriate Venous Thromboembolism Prophylaxis in Patients With Orthopaedic Trauma With Symptom-Driven Vascular and Radiographic Studies

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 8 publications

References 34 publications

A Stitch in Time Saves Clots: Venous Thromboembolism Chemoprophylaxis in Traumatic Brain Injury

A Stitch in Time Saves Clots: Venous Thromboembolism Chemoprophylaxis in Traumatic Brain Injury

Curative Effects of Remote Home Management Combined with Feng’s Spinal Manipulation on the Treatment of Elderly Patients with Lumbar Disc Herniation

Recommendations from the ICM-VTE: Trauma

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