Posttrauma Thromboembolism Prophylaxis

Abstract

The ability to identify a population with a high incidence of thromboembolism by using the RAPT score to detect asymptomatic DVT, and the suggested advantage of low molecular weight heparin, all support the need for an appropriately powered randomized clinical trial.

Thromboprophylaxis following major skeletal trauma: a systematic review

“…None of the papers described that their randomisation process was concealed, providing a further methodological weakness as an additional source of allocation bias [31,32]. Finally, Greenfield et al [19] concluded that based on the literature, they suggested that a DVT rate of 15% in a trauma population would require a sample size of 2,500 patients to detect a reduction in DVT to 7%. Since none of the studies reviewed based their sample sizes on power calculations, there is a possibility that these studies committed a type II statistical error [32].…”

“…A summary of the demographic characteristics of the cohorts recruited in these reviewed papers is presented as Table 2. Three studies were excluded on final appraisal [18,19]. Stannard et al's [18] study was excluded since whilst the study reported that their cohort of high-energy multi-trauma patients received either mechanical compression or low molecular weight heparin (LMWH), they did not present the differences in incidence or VTE events.…”

“…Stannard et al's [18] study was excluded since whilst the study reported that their cohort of high-energy multi-trauma patients received either mechanical compression or low molecular weight heparin (LMWH), they did not present the differences in incidence or VTE events. Greenfield et al's [19] study of IVC filters was excluded as not all patient outcomes could be accounted for on reviewing the reported results of this study. Finally Knudson et al's [20] study was excluded as on review, it appeared that in the design of this study, patients allocated to the low dose heparin (LDH) group, did not receive the treatment which they were allocated to, therefore making the analysis of these data very difficult to interpret for this review.…”

Prophylactic Insertion of Optional Vena Cava Filters in High-Risk Trauma Patients

“…Prophylactic VCF placement was evaluated according to the guidelines of the Eastern Association for the Surgery of Trauma (EAST) [11]. In addition, the patient's risk for VTE was assessed using the RAPT score developed by Greenfield and co-workers [3] (Table 1). High-risk trauma patients (RAPT score ≥ 5) were evaluated for prophylactic VCF when pharmacologic prophylaxis for VTE was contraindicated.…”

“…The incidence for venous thromboembolic events (VTE) varies widely in the literature from 5 to 58% [1][2][3]. In some series, PE represents the third major cause of death after trauma in those patients who survive longer than 24 h after injury [4].…”