The Practice of Venous Thromboembolism Prophylaxis in the Major Trauma Patient

Nathens, Avery B.; McMurray, Megan K.; Cuschieri, Joseph; Durr, Emily A.; Moore, Ernest E.; Bankey, Paul E.; Freeman, Brad; Harbrecht, Brian G.; Johnson, Jeffrey L.; Minei, Joseph P.; McKinley, Bruce A.; Moore, Frederick A.; Shapiro, Michael B.; West, Michael A.; Tompkins, Ronald G.; Maier, Ronald V.

doi:10.1097/ta.0b013e318031b5f5

Cited by 111 publications

(99 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…61,[177][178][179] The risk is probably highest among patients with spinal trauma (2.2% despite near-universal prophylaxis), acute spinal cord injury (5%-6%), or traumatic brain injury (3%-5% among those who received pharmacologic prophylaxis within 24 to 48 h; up to 15% when initiation of pharmacologic prophylaxis was delayed beyond 48 h). [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.…”

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

(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

show abstract

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

“…22,23 This finding is in stark contrast to another study that reported prophylaxis orders in 25% of patients within 48 hours after receiving trauma. 24 These data and our baseline compliance rate suggest that trauma patients may be getting VTE prophylaxis at higher rates than other medical and surgi- cal patients. 5,6 Perhaps a well-defined protocol for trauma care, which has been shown to improve outcomes in trauma, 25,26 also helps to increase compliance with VTE prophylaxis.…”

Section: Commentmentioning

confidence: 88%

Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma

et al. 2012

View full text Add to dashboard Cite

Venous thromboembolism is associated with substantial morbidity and mortality and is largely preventable. Despite this fact, appropriate prophylaxis is vastly underutilized. To improve compliance with best practice prophylaxis for VTE in hospitalized trauma patients, we implemented a mandatory computerized provider order entry-based clinical decision support tool. The system required completion of checklists of VTE risk factors and contraindications to pharmacologic prophylaxis. With this tool, we were able to determine a patient's risk stratification level and recommend appropriate prophylaxis. To evaluate the effect of our mandatory computerized provider order entry-based clinical decision support tool on compliance with prophylaxis guidelines for venous thromboembolism (VTE) and VTE outcomes among admitted adult trauma patients.

show abstract

“…36 Nathens et al demonstrated that delaying PTP in major trauma patients after day 4 increases the risk of VTE threefold. 37 There was significant heterogeneity among the incidences of VTE within the early group of our included studies, which ranged from 4.2% to 13.8%. This is higher than two studies by Norwood et al looking at single cohorts of TBI patients started on PTP within 48 h. In the first study, 7 they assessed 150 patients and found a VTE incidence of 2% in 106 of the patients who were screened with duplex ultrasound 24 h from hospital discharge.…”

Section: Safetymentioning

confidence: 95%

Safety and Efficacy of Early Pharmacological Thromboprophylaxis in Traumatic Brain Injury: Systematic Review and Meta-Analysis

Jamjoom

2013

Journal of Neurotrauma

View full text Add to dashboard Cite

Patients with traumatic brain injury (TBI) are at an increased risk of developing venous thromboembolic events (VTE). Pharmacological thromboprophylaxis (PTP) is routinely delayed because of concerns of exacerbating intracranial hemorrhage (ICH). The aim of this review is to examine the literature and assimilate suitable data to assess the safety and efficacy of PTP administered within 72 h in TBI patients. We systematically searched the literature for randomized controlled trials or cohort studies reporting on the timing of PTP in TBI. We dichotomized the timing of PTP to early and late at 72 h post-injury. The rates of VTE and ICH progression were our primary endpoints and were pooled using a fixed-effects model. A total of five retrospective cohort studies were included within the review including a total of 1624 patients, of which 713 received early PTP and 911 received late PTP. Within the early and late group there was a total of 43 and 106 VTE respectively, with a risk ratio of 0.52 (0.37, 0.73). Assessing safety, the relative risk of ICH progression in the early compared with the late PTP group was 0.64 (0.35, 1.14). Based on the available literature, we can tentatively conclude that early PTP (<72 h) reduces the risk of VTE without affecting progression of ICH. However, much work is yet to be done to better clarify ICH subtypes at risk of progression and the implementation of evidence-based guidelines backed up with randomized control trial level evidence.

show abstract

The Practice of Venous Thromboembolism Prophylaxis in the Major Trauma Patient

Cited by 111 publications

References 14 publications

Prevention of VTE in Nonorthopedic Surgical Patients

Prevention of VTE in Nonorthopedic Surgical Patients

Improved Prophylaxis and Decreased Rates of Preventable Harm With the Use of a Mandatory Computerized Clinical Decision Support Tool for Prophylaxis for Venous Thromboembolism in Trauma

Safety and Efficacy of Early Pharmacological Thromboprophylaxis in Traumatic Brain Injury: Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About