Prevention of Venous Thromboembolism after Injury: An Evidence-Based Report???Part II: Analysis of Risk Factors and Evaluation of the Role of Vena Caval Filters

Velmahos, George C.; Kern, Jack W.; Chan, Linda S.; Oder, Danila; Murray, James A.; Shekelle, Paul G

doi:10.1097/00005373-200007000-00021

Cited by 132 publications

(66 citation statements)

References 23 publications

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“…[180][181][182][183][184][185] A systematic review identifi ed patients with spinal fractures (OR, 2.3; 95% CI, 1.4-3.6) or spinal cord injury (OR, 3.0; 95% CI, 1.8-5.4) as having a higher risk of VTE than other patients with trauma. 186 Older age has also been implicated as a risk factor for VTE in a number of studies. 177,178,187 Other independent risk factors for VTE, inconsistent across studies, included blood transfusion, surgery, femoral or tibial fracture, and spinal cord injury 177 ; head injury, major operation, lower-extremity fracture, venous injury, and (especially) .…”

Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Vtementioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,784

744

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(Grade 2C) prophylaxis be used other than early ambulation. For patients at low risk for VTE ( ‫ف‬ 1.5%), we suggest mechanical prophylaxis, preferably with intermittent pneumatic compression (IPC), over no prophylaxis (Grade 2C). For patients at moderate risk for VTE ( ‫ف‬ 3%) who are not at high risk for major bleeding complications, we suggest low-molecular-weight heparin (LMWH) (Grade 2B), low-dose unfractionated heparin (Grade 2B), or mechanical prophylaxis with IPC (Grade 2C) over no prophylaxis. For patients at high risk for VTE ( ‫ف‬ 6%) who are not at high risk for major bleeding complications, we recommend pharmacologic prophylaxis with LMWH (Grade 1B) or low-dose unfractionated heparin (Grade 1B) over no prophylaxis. In these patients, we suggest adding mechanical prophylaxis with elastic stockings or IPC to pharmacologic prophylaxis (Grade 2C). For patients at high risk for VTE undergoing abdominal or pelvic surgery for cancer, we recommend extended-duration, postoperative, pharmacologic prophylaxis (4 weeks) with LMWH over limited-duration prophylaxis (Grade 1B). For patients at moderate to high risk for VTE who are at high risk for major bleeding complications or those in whom the consequences of bleeding are believed to be particularly severe, we suggest use of mechanical prophylaxis, preferably with IPC, over no prophylaxis until the risk of bleeding diminishes and pharmacologic prophylaxis may be initiated (Grade 2C). For patients in all risk groups, we suggest that an inferior vena cava fi lter not be used for primary VTE prevention (Grade 2C) and that surveillance with venous compression ultrasonography should not be performed (Grade 2C). We developed similar recommendations for other nonorthopedic surgical populations. Conclusions: Optimal thromboprophylaxis in nonorthopedic surgical patients will consider the risks of VTE and bleeding complications as well as the values and preferences of individual patients. CHEST 2012; 141(2)(Suppl):e227S-e277SAbbreviations: CABG 5 coronary artery bypass graft; ES 5 elastic stockings; ICH 5 intracranial hemorrhage; IPC 5 intermittent pneumatic compression; IVC 5 inferior vena cava; LDUH 5 low-dose unfractionated heparin; LMWH 5 low-molecular-weight heparin; PE 5 pulmonary embolism; QALY 5 quality-adjusted life year; RR 5 risk ratio; VCU 5 venous compression ultrasonography

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Section: Baseline Risk Risk Factors and Risk Stratifi Cation For Vtementioning

confidence: 99%

Prevention of VTE in Nonorthopedic Surgical Patients

Gould

García

Wren

et al. 2012

Chest

1,784

744

View full text Add to dashboard Cite

show abstract

“…Trauma carries a high risk for deep venous thrombosis (DVT) and pulmonary emboli (PE) due to several factors, including prolonged immobility and extremity injuries [83]. To address prophylaxis against venous thromboembolism, Geerts and colleagues conducted a double-blinded RCT comparing unfractionated heparin (UFH) with lowmolecular-weight heparin (LMWH), both given subcutaneously every 12 h, in 344 major trauma patients [84].…”

Section: Critical Carementioning

confidence: 99%

Randomized controlled trials affecting polytrauma care

Mejaddam

Velmahos

2011

Eur J Trauma Emerg Surg

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Trauma remains the leading cause of death in the world in patients under 45 years of age. The evaluation, resuscitation, and appropriate management of polytraumatized patients are paramount to successful outcomes. The advance of evidence-based medicine has had a powerful and positive impact on trauma care, even though the nature of many traumatic injuries lends itself poorly to study in a randomized fashion. During the initial management of bleeding patients, hypotensive resuscitation prior to surgical control has found strong support in the literature, and its use has been adopted by many surgeons. Head injury is the most common cause of traumatic death, and while high-level evidence is limited, adherence to management guidelines is associated with improved outcomes. For abdominal trauma, the concept of damage control surgery, while popular, has never been put to the test in a randomized controlled trial. Numerous randomized trials in the field of critical care have affected the management of severely injured patients, including intensive insulin therapy and low tidal volume ventilation in patients with compromised respiratory function. Finally, a multidisciplinary approach to trauma care in designated trauma centers allows for improved outcomes in polytraumatized patients.

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“…As VTE is the third most common cause of death following major trauma if the patient survives the first 24 h [50], and as DVT occurs in 58% of patients if no prophylaxis is given and 27% who receive prophylaxis [51], optional filters seem like a reasonable approach to reduce PE in this setting as this risk is temporally limited. Within the trauma literature, there are however inconsistencies in the success of optional filters in VTE prophylaxis, with some studies reporting no reduction in PE rates [52][53][54]. Another prophylactic filter indication emerging is in the peri-operative setting of surgical bariatric patients, who are a known high-risk population for venous thromboembolism.…”

Section: Indications For Optional Caval Filter Insertionmentioning

confidence: 99%

Optional inferior vena caval filters: where are we now?

2008

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With the advent of newer optional/retrievable inferior vena caval filters, there has been a rise in the number of filters inserted globally. This review article examines the currently available approved optional filter models, outlines the clinical indications for filter insertion and examines the expanding indications. Additionally, the available evidence behind the use of optional filters is reviewed, the issue of anticoagulation is discussed and possible future filter developments are considered.

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Prevention of Venous Thromboembolism after Injury: An Evidence-Based Report???Part II: Analysis of Risk Factors and Evaluation of the Role of Vena Caval Filters

Abstract: Spinal injuries, spinal cord injuries, and age are risk factors for development of DVT. Prophylactic placement of VCF in selected trauma patients may decrease the incidence of pulmonary embolism. Future research with well-designed studies is required to provide definitive answers.

Cited by 132 publications

References 23 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

Randomized controlled trials affecting polytrauma care

Optional inferior vena caval filters: where are we now?

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