Fondaparinux for Prevention of Venous Thromboembolism in High-Risk Trauma Patients: A Pilot Study

Lu, Jong-Ping; Knudson, M. Margaret; Bir, Natasha D.; Kallet, Richard H; Atkinson, Keith

doi:10.1016/j.jamcollsurg.2009.08.001

Cited by 21 publications

(12 citation statements)

References 17 publications

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“…In severely injured patients, VTE remains a major cause of potentially preventable death despite considerable prophylactic efforts particularly in those who are believed to have contraindications to receiving a heparin drug [8, 21]. Because of the fact that safer and more effective prophylactic measures are needed for high-risk trauma patients, search for new solutions is ongoing.…”

Section: Pharmacologic Prophylaxismentioning

confidence: 99%

“…Fondaparinux is a nonheparin drug and the first synthetic pentasaccharide selectively inhibiting Factor Xa [21, 67, 68]. Along with its antithrombotic efficacy in preventing VTE after elective orthopaedic operations and in selected high-risk abdominal surgical patients [21], the safety of fondaparinux has been documented in several Phase II and III clinical trials [68].…”

Section: Pharmacologic Prophylaxismentioning

confidence: 99%

“…Along with its antithrombotic efficacy in preventing VTE after elective orthopaedic operations and in selected high-risk abdominal surgical patients [21], the safety of fondaparinux has been documented in several Phase II and III clinical trials [68]. Two studies were performed to detect the efficacy of fondaparinux in hip fracture surgery [69, 70].…”

Section: Pharmacologic Prophylaxismentioning

confidence: 99%

“…The second study by the same group in 2004 revealed a 1.4% incidence of DVT following a hip fracture surgery [70]. Despite these studies, Fondaparinux has never been used in trauma patients until a pilot study was performed by Lu et al [21] in 2009. In this study, authors found a 4.6% overall incidence of DVT and a 1.2% incidence of DVT in patients receiving fondaparinux.…”

Section: Pharmacologic Prophylaxismentioning

confidence: 99%

“…Methods of prophylaxis and detection continue to improve; however, a significant proportion of patients still develop VTE [8, 21]. In addition, the difficulty in determining optimal treatment is further complicated by the presence of occult DVTs at a 60% rate of occurrence [17, 22].…”

Section: Introductionmentioning

confidence: 99%

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Deep Vein Thrombosis Prophylaxis in Trauma Patients

2011

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Deep vein thrombosis (DVT) and pulmonary embolism (PE) are known collectively as venous thromboembolism (VTE). Venous thromboembolic events are common and potentially life-threatening complications following trauma with an incidence of 5 to 63%. DVT prophylaxis is essential in the management of trauma patients. Currently, the optimal VTE prophylaxis strategy for trauma patients is unknown. Traditionally, pelvic and lower extremity fractures, head injury, and prolonged immobilization have been considered risk factors for VTE; however it is unclear which combination of risk factors defines a high-risk group. Modalities available for trauma patient thromboprophylaxis are classified into pharmacologic anticoagulation, mechanical prophylaxis, and inferior vena cava (IVC) filters. The available pharmacologic agents include low-dose heparin (LDH), low molecular weight heparin (LMWH), and factor Xa inhibitors. Mechanical prophylaxis methods include graduated compression stockings (GCSs), pneumatic compression devices (PCDs), and A-V foot pumps. IVCs are traditionally used in high risk patients in whom pharmacological prophylaxis is contraindicated. Both EAST and ACCP guidelines recommend primary use of LMWHs in trauma patients; however there are still controversies regarding the definitive VTE prophylaxis in trauma patients. Large randomized prospective clinical studies would be required to provide level I evidence to define the optimal VTE prophylaxis in trauma patients.

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Section: Pharmacologic Prophylaxismentioning

confidence: 99%