Guidelines for the prevention of venous thromboembolism in hospitalized patients with pelvi-acetabular trauma

Aggarwal, Sameer; Patel, Sandeep; Vashisht, Saurabh; Kumar, Vishal; Sehgal, Inderpaul Singh; Chauhan, Rajeev; Chaluvashetty, Sreedhara B; Kumar, Ketan; Jindal, Karan

doi:10.1016/j.jcot.2020.09.011

Cited by 12 publications

(13 citation statements)

References 62 publications

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“…12 The desire to prevent VTE in the trauma patient is well accepted by orthopaedic traumatologists and there have been studies performed to investigate ways that we can optimize high-risk patients. 18,19 We know the significant effect that chemical thromboprophylaxis has on development of VTE in these injuries. In a prospective study investigating the incidence of DVT and PE after major trauma, Geerts et al used serial impedance plethysmography and lower-extremity contrast venography to detect deep-vein thrombosis postoperative and none of the patients received thromboprophylaxis.…”

Section: Discussionmentioning

confidence: 99%

Higher altitude leads to increased risk of venous thromboembolism after acetabular and pelvic ring injury

Broggi

Yoon

Allen

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Introduction: There is a high post-operative incidence of venous thromboembolisms (VTEs), specifically deep vein thrombosis (DVT) and pulmonary embolism (PE), in pelvic ring and acetabular fractures, and identification of risk factors for VTEs is crucial to decrease this highly morbid complication. High altitudes have a known physiological effect on the body that may predispose patients to developing VTEs in the postoperative period. The purpose of this study was to investigate the relationship between pelvic ring and acetabular fractures occurring at high altitudes and the development of postoperative VTEs. Methods: In this retrospective study, the Truven MarketScan claims database was used to identify patients who underwent surgical fixation of a pelvic ring and/or acetabular fracture from January 2009 to December 2018 using Current Procedural Terminology (CPT) codes. Patient characteristics, including medical comorbidities, were collected. The zip codes of where the surgeries took place were used to determine recovery altitude and patients were separated into either the high altitude (>4000 feet) or low altitude (<100 feet) cohorts. Chi-squared and multivariate analyses were performed to investigate the association between altitude and the development of VTE postoperatively. Results: In total, 68,923 patients were included for analysis. At 30-days postoperatively, a higher altitude was associated with increased odds of developing a PE (OR 1.47, p ¼ 0.019). At 90-days postoperatively, a higher altitude was associated with increased odds of DVT (OR 1.24, p ¼ 0.029) and PE (OR 1.63, p < 0.001). Conclusion: Surgical fixation of pelvic ring and acetabular fractures performed at a higher altitude (>4,000feet) are associated with increased odds of developing a PE in the first 30 days as well as developing a DVT or PE at 90 days postoperatively. Future prospective studies are needed to further elucidate the causality of altitude on the development of postoperative VTEs.

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Section: Discussionmentioning

confidence: 99%

Higher altitude leads to increased risk of venous thromboembolism after acetabular and pelvic ring injury

Broggi

Yoon

Allen

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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“…Geerts et al, also concluded in a randomized double blinded study that LMWH was more effective than LDH in preventing VTE after major trauma 16 . Aggarwal et al, concluded in their guidelines for prevention of VTE in hospitalized patients with pelvis and acetabular fractures that LMWH is the preferred agent of choice 8 .…”

Section: - What Is the Most Optimal Vte Prophylaxis In Patients With ...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Trauma

2022

Journal of Bone and Joint Surgery

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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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“…The prevalence of VTE is more in pelvi-acetabular trauma in comparison to hip arthroplasty. This is attributed to multiple factors including high velocity injury, disruption of pelvic vessels, immobilization for long duration and manipulation during surgical procedure ( Aggarwal et al, 2020 ). Comprehensive data show that pulmonary embolism accounts for 10–40% of all deaths in all cases undergoing hip fracture surgery ( Dahl et al, 2005 ).…”

Section: Ivcf For Orthopaedic Management Of Vtementioning

confidence: 99%

“…Among these, prophylactic IVCF is not recommended for patients in Category 3: Critically ill patient presenting to emergency department (strong recommendation, moderate evidence). For Category 4: Patient with established DVT and planned for surgery placement of IVCF is recommended (weak recommendation, very low evidence) ( Aggarwal et al, 2020 ).…”

Section: Ivcf For Orthopaedic Management Of Vtementioning

confidence: 99%

The application of inferior vena cava filters in orthopaedics and current research advances

Wang

Zhou

et al. 2022

Front. Bioeng. Biotechnol.

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Deep vein thrombosis is a common clinical peripheral vascular disease that occurs frequently in orthopaedic patients and may lead to pulmonary embolism (PE) if the thrombus is dislodged. pulmonary embolism can be prevented by placing an inferior vena cava filter (IVCF) to intercept the dislodged thrombus. Thus, IVCFs play an important role in orthopaedics. However, the occurrence of complications after inferior vena cava filter placement, particularly recurrent thromboembolism, makes it necessary to carefully assess the risk-benefit of filter placement. There is no accepted statement as to whether IVCF should be placed in orthopaedic patients. Based on the problems currently displayed in the use of IVCFs, an ideal IVCF is proposed that does not affect the vessel wall and haemodynamics and intercepts thrombi well. The biodegradable filters that currently exist come close to the description of an ideal filter that can reduce the occurrence of various complications. Currently available biodegradable IVCFs consist of various organic polymeric materials. Biodegradable metals have shown good performance in making biodegradable IVCFs. However, among the available experimental studies on degradable filters, there are no experimental studies on filters made of degradable metals. This article reviews the use of IVCFs in orthopaedics, the current status of filters and the progress of research into biodegradable vena cava filters and suggests possible future developments based on the published literature by an electronic search of PubMed and Medline databases for articles related to IVCFs searchable by October 2022 and a manual search for citations to relevant studies.

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Guidelines for the prevention of venous thromboembolism in hospitalized patients with pelvi-acetabular trauma

Cited by 12 publications

References 62 publications

Higher altitude leads to increased risk of venous thromboembolism after acetabular and pelvic ring injury

Higher altitude leads to increased risk of venous thromboembolism after acetabular and pelvic ring injury

Recommendations from the ICM-VTE: Trauma

The application of inferior vena cava filters in orthopaedics and current research advances

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