Venous thromboembolism after severe trauma: Incidence, risk factors and outcome

Paffrath, Thomas; Wafaisade, Arasch; Lefering, Rolf; Simanski, C.; Bouillon, Bertil; Spanholtz, Timo; Wutzler, Sebastian; Maegele, Marc

doi:10.1016/j.injury.2009.06.010

Cited by 192 publications

(172 citation statements)

References 30 publications

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“…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%

“…Venous thromboembolism potentially leads to life‐threatening complications after traumatic injury, which remains a major problem worldwide 1, 2. However, the epidemiology of VTE after major trauma in Japanese patients has not been well evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…Venous thromboembolism (VTE), which consists of deep venous thrombosis (DVT) and pulmonary embolism, is a common complication after major trauma associated with increased mortality and morbidity 1, 2. 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.…”

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: 84%

Section: Discussionmentioning

confidence: 99%

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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“…After a thorough literature review of guidelines in current practice, the senior authors of this study developed the paper-based Thrombotic Risk Assessment Questionary according to evidence-based guidelines,10 the literatures on risk factors,116 and risk assessment strategies 17–21. Various risk factors were collected and included in the assessment table, and the validity of risk factors has been confirmed or detailed in the relevant literatures 218.…”

Section: Methodsmentioning

confidence: 99%

Thrombotic risk assessment questionary helps increase the use of thromboprophylaxis for patients with pelvic and acetabular fractures

Wang

Chen

et al. 2012

IJOO

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Background:Pelvic and acetabular fractures have been known as one of the high risk factors for developing deep vein thrombosis (DVT), but thromboprophylaxis for patients with such fractures remains underused despite its widely accepted benefits. Current guidelines have not been universally adopted in clinical practice. The purpose of this study is to introduce a Thrombotic Risk Assessment Questionary (assessment table) according to evidence-based guidelines and evaluate its impact on the use of thromboprophylaxis for patients with pelvic and acetabular fractures.Materials and Methods:We retrospectively reviewed 305 consecutive patients with pelvic and acetabular fractures from August 1, 2008 through September 30, 2010. The control group without using the assessment table included 153 patients admitted during the first 13 months, and the assessment group using the assessment table included 152 patients admitted during the following months. Data on clinical outcomes of DVT, the number of patients receiving prophylaxis, and the time of the first dose of anticoagulant were collected.Results:Compared with the control group, Patients using the assessment table were more likely to be given DVT prophylaxis (84.2% vs. 37.3%, P < 0.05) and the time of the first dose of anticoagulant was reduced (4.32 days ± 4.78 days vs. 6.6 days ± 5.96 days, P < 0.05). Patients in the assessment group had lower risk of developing DVT (8.6% vs. 20.3%, P < 0.05).Conclusion:The assessment table can significantly improve the use of thromboprophylaxis after pelvic and acetabular fractures, which will likely reduce the incidence of DVT. Developing individual hospital prophylaxis strategy is an effective way to determine whether hospitalized patients should receive pharmacologic and/or mechanical prophylaxis or not.

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“…Orthopedic trauma has a relatively high incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) [64], with risk increased by injury severity score (ISS) >50, greater than two surgeries, a history of venous thromboembolism (VTE), comorbidities, traumatic brain injury, prolonged hospitalization, and reduced mobility [64][65][66]. In a cohort study of 18,151 orthopedic and trauma patients, Gudipati et al [66] found that PE still developed in these patients despite mechanical and chemical thromboprophylaxis, implicating the importance of optimizing other modifiable risk factors.…”

Section: Physiologic Value Of Lower Extremity Rehabilitationmentioning

confidence: 99%

Rehabilitation of Lower Extremity Trauma: a Review of Principles and Military Perspective on Future Directions

et al. 2015

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The rehabilitation of individuals with lower extremity injury is a common but complex problem for the surgical and rehabilitative teams. Basic science tenets of fracture and soft tissue reconstruction and healing guide postoperative weight-bearing and range of motion protocols. In addition to the physiological complications associated with the injury severity, patient outcomes are often influenced by other factors such as patient compliance, pain, depression, and the negative effects of immobility. As a result, novel rehabilitative protocols to include early weight bearing, continuous passive motion, psychosocial intervention, and multimodal pain management are becoming more popular to facilitate rehabilitation and improved patient outcomes. Further supporting the need for this shift in paradigm thinking are outcome studies of both civilian and military trauma patients that demonstrate the negative impact that psychological, social, and economical factors have on outcomes. This report highlights the experience that our team has had in instituting comprehensive rehabilitation strategies to treat injured service members with complex lower extremity trauma from combat.

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Venous thromboembolism after severe trauma: Incidence, risk factors and outcome

Cited by 192 publications

References 30 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

Thrombotic risk assessment questionary helps increase the use of thromboprophylaxis for patients with pelvic and acetabular fractures

Rehabilitation of Lower Extremity Trauma: a Review of Principles and Military Perspective on Future Directions

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