Thromboembolism After Trauma

Knudson, M. Margaret; Ikossi, Danagra G.; Khaw, Linda; Morabito, Diane; Speetzen, Larisa S.

doi:10.1097/01.sla.0000137138.40116.6c

Cited by 423 publications

(156 citation statements)

References 45 publications

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“…Various risk factors have been identified as being associated with VTE in trauma patients 1, 5, 23, 24, 25. Our results, in which higher ISS and the presence of lower extremity fractures were the significant risk factors for VTE, were consistent with data from prior studies 16…”

Section: Discussionsupporting

confidence: 91%

“…showed that the incidence of DVT with cervical spinal cord injury was 10%. Our study found that the incidence of VTE among a cohort of trauma patients with severe injury (median ISS, 20) was 32%, which was as high as previously reported, or higher 1, 2, 3, 4, 5, 6, 7…”

Section: Discussionsupporting

confidence: 84%

“…The incidence of VTE after trauma is reported to vary from 0.36% to 58%, which depends on patient demographics, study period, detection method, and use and type of VTE prophylaxis 1, 3, 4, 5, 6, 7. Incidence also significantly varies by race.…”

Section: Introductionmentioning

confidence: 99%

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Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

Yumoto

Naito

Yamakawa

et al. 2017

Acute Medicine & Surgery

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AimVenous thromboembolism (VTE) can be a life‐threatening complication after major trauma. The aim of this study was to investigate the epidemiology of VTE and to assess the usefulness of D‐dimer for screening for VTE in major trauma cases among the Japanese population.MethodsWe examined a single‐center retrospective cohort of severely injured trauma patients who had been admitted to the emergency intensive care unit at Okayama University Hospital (Okayama, Japan) from April 2013 through to March 2016. Venous thromboembolism was confirmed by computed tomography angiography and computed tomography venography, which was determined based on the attending physician monitoring daily D‐dimer levels. Independent risk factors for VTE were determined by multiple logistic regression analysis. D‐dimer levels were evaluated using area under the receiver operating characteristic curve (AUROC) to predict VTE.ResultsThe study cohort consisted of 204 trauma patients (median Injury Severity Score, 20). Of the 204 patients, 65 (32%) developed VTE. The median time from admission to VTE diagnosis was 10 days. In multiple logistic regression analysis, higher Injury Severity Score and the presence of lower extremity fractures were revealed to be a risk factor for VTE. D‐dimer levels at day 10 showed moderate accuracy, of which the AUROC was 0.785 (95% confidence interval, 0.704–0.866; P < 0.001). The cut‐off that maximized the Youden index was 12.45 μg/mL.ConclusionsAt least one of every three major trauma patients had potential development of VTE at a median of 10 days following admission to the intensive care unit. D‐dimer levels on day 10 can be a useful predictor of VTE.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 84%

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Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

Yumoto

Naito

Yamakawa

et al. 2017

Acute Medicine & Surgery

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“…We also examined the adjusted association of admission INR (as a continuous variable) and several secondary outcomes (MOF, ARDS, and VTE) using Cox proportional hazard analysis to account for the competing risk of mortality. Selection of adjustment variables for each model occurred a priori based on literature review (10-12, 42-47). Subjects with incomplete data for adjustment variables were excluded from the primary analyses but included in multiply imputed sensitivity analyses (see below).…”

Section: Methodsmentioning

confidence: 99%

An International Normalized Ratio–Based Definition of Acute Traumatic Coagulopathy Is Associated With Mortality, Venous Thromboembolism, and Multiple Organ Failure After Injury

Peltan

Vusse

Maier

et al. 2015

Critical Care Medicine

110

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Objective Acute traumatic coagulopathy (ATC) is associated with adverse outcomes including death. Previous studies examining ATC's relationship with mortality are limited by inconsistent criteria for syndrome diagnosis, inadequate control of confounding and single-center designs. In this study, we validated the admission international normalized ratio (INR) as an independent risk factor for death and other adverse outcomes after trauma and compared two common INR-based definitions for ATC. Design Multicenter prospective observational study. Setting Nine level I trauma centers in the United States. Patients 1,031 blunt trauma patients with hemorrhagic shock. Interventions None. Measurements and Main Results INR exhibited a positive adjusted association with all-cause in-hospital mortality, hemorrhagic shock-associated in-hospital mortality, venous thromboembolism, and multiple organ failure. ATC affected 50% of subjects if defined as an INR >1.2 and 21% of subjects if defined by INR >1.5. After adjustment for potential confounders, ATC defined as an INR >1.5 was significantly associated with all-cause death (OR 1.88, p<0.001), hemorrhagic shock-associated death (OR 2.44, p=0.001), venous thromboembolism (1.73, p<0.001), and multiple organ failure (OR 1.38, p=0.02). ATC defined as an INR >1.2 was not associated with an increased risk for the studied outcomes. Conclusions Elevated INR on hospital admission is a risk factor for mortality and morbidity after severe trauma. Our results confirm this association in a prospectively-assembled multicenter cohort of severely injured patients. Defining ATC using an INR >1.5 but not an INR >1.2 identified a clinically-meaningful subset of trauma patients who, adjusting for confounding factors, suffered more adverse outcomes. Targeting future therapies for ATC to patients with an INR >1.5 may yield greater returns than using a lower INR threshold.

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“…1 Patients with TBI are at increased risk of developing venous thromboembolism (VTE) due to their prolonged immobilization and hypercoagulable state. 2-5 Denson et al reported a VTE incidence of 25% in patients experiencing isolated TBI, compared to 2% in all trauma patients and 18% in high risk patients, and suggested that early prophylaxis against VTE was warranted among TBI patients. 6 The incidence of VTE may be as high as 54% among patients with major head trauma not treated with mechanical or pharmacological prophylaxis.…”

Section: Introductionmentioning

confidence: 99%

A Systematic Review of the Benefits and Risks of Anticoagulation Following Traumatic Brain Injury

Shen

Dutcher

Palmer

et al. 2015

Journal of Head Trauma Rehabilitation

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Objective The objective of the study was Tto synthesize the existing literature on benefits and risks of anticoagulant use after traumatic brain injury (TBI). Design: Systematic review A literature search was performed in Medline, IPA, Health Star and CINAHL on October 11, 2012 and updated on September 2, 2013, using terms related to TBI and anticoagulants. Main Measures Human studies evaluating the effects of post-TBI anticoagulation on venous thromboembolism (VTE), hemorrhage, mortality or coagulation parameters with original analyses were eligible for the review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed throughout the conduct of the review. Results Thirty-nine eligible studies were identified from the literature, of which 23 studies with complete information on post-TBI anticoagulant use and patient outcomes were summarized in this review. Meta-analysis was unwarranted due to varying methodological design and quality of the studies. Twenty-one studies focused on the effects of pharmacological thromboprophylaxis (PTP) post-TBI on VTE and/or progression of intracranial hemorrhage (ICH) while two RCTs analyzed coagulation parameters as the result of anticoagulation. Conclusion PTP appears to be safe among TBI patients with stabilized hemorrhagic patterns. More evidence is needed regarding effectiveness of PTP in preventing VTE as well as preferred agent, dose and timing for PTP.

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Thromboembolism After Trauma

Abstract: Patients who need VTE prophylaxis after trauma can be identified based on risk factors. The use of prophylactic vena cava filters should be re-examined.

Cited by 423 publications

References 45 publications

Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

Venous thromboembolism in major trauma patients: a single‐center retrospective cohort study of the epidemiology and utility of D‐dimer for screening

An International Normalized Ratio–Based Definition of Acute Traumatic Coagulopathy Is Associated With Mortality, Venous Thromboembolism, and Multiple Organ Failure After Injury

A Systematic Review of the Benefits and Risks of Anticoagulation Following Traumatic Brain Injury

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