Venous Thromboembolism Chemoprophylaxis in Trauma and Emergency General Surgery Patients: A Systematic Review

Sanchez, Carol; Nguyen, Jackie; Baroutjian, Amanda; Gill, Sabrina; McKenney, Mark; Elkbuli, Adel

doi:10.1097/jtn.0000000000000606

Cited by 4 publications

(3 citation statements)

References 54 publications

(92 reference statements)

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“…In addition, the higher the education level of patients, the lower the incidence of DVT, which may be related to the higher acceptance of the disease, thromboprophylaxis knowledge, and the higher compliance with thromboprophylaxis practice. ISS, as the most commonly used assessment tool for the disease severity of multiple trauma patients, was considered to be closely related to the risk strati cation of DVT in previous studies [32][33][34]. We also con rmed that the ISS of the thrombotic group was signi cantly higher than that of the non-thrombotic group, and the difference was statistically signi cant.…”

Section: Discussionsupporting

confidence: 64%

Risk assessment scales to predict risk of lower extremity deep vein thrombosis among multiple trauma patients: A prospective cohort study

Chen

Sun

Kong

2023

Preprint

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Background Deep vein thrombosis (DVT) is a common complication in orthopedic patients. Previous studies have focused on major orthopedic surgery.There are few studies with multiple trauma. We aimed to describe the prevalence of DVT and compare the predictive power of the different risk assessment scales in patients with multiple trauma.Methods This prospective cohort study involved multiple trauma patients admitted to our hospital between October 2021 and December 2022. Data were prospectively collected for thrombotic risk assessments using the Risk Assessment Profile for thromboembolism(RAPT), the DVT risk assessment score (DRAS), and the Trauma Embolic Scoring System (TESS), respectively. The receiver operation characteristic (ROC) curve and the area under the curve (AUC) were evaluated to compare the predictive power. Doppler ultrasound was used to determine DVT incidence.Results A total of 210 patients were included, and the incidence of DVT was 26.19%. Distal DVT accounted for 87.27%; postoperative DVT, 72.73%; and bilateral lower extremity thrombosis, 30.91%. There were significant differences in age, education degree, pelvic fracture, surgery, ISS, D-dimmer level, length of hospital stay and ICU stay between the thrombosis group and the non-thrombosis group. The AUCs for RAPT, DRAS, and TESS were 0.737, 0.710, and 0.683, respectively. The RAPT had better predictive value, but there were no significant differences between the three ROC curves.Conclusions The incidence of DVT was relatively high during hospitalization. We prospectively validated the tests to predict risk of DVT among patients with multiple trauma to help trauma surgeons in the clinical administration of DVT prophylaxis.

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Section: Discussionsupporting

confidence: 64%

Risk assessment scales to predict risk of lower extremity deep vein thrombosis among multiple trauma patients: A prospective cohort study

Chen

Sun

Kong

2023

Preprint

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“…1 Traumatic brain injury patients are at a high risk of developing deep vein thrombosis (DVT) and pulmonary embolism (PE) due to prolonged immobility, physiologic hypercoagulability, and delay to chemical venous thromboembolism (VTE) prophylaxis. [2][3][4] The development of VTE in TBI patients carries a two-fold increased risk of morbidity and mortality. 5 The optimal timing of VTE prophylaxis initiation in TBI patients is controversial.…”

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confidence: 99%

“…Traumatic brain injury (TBI) is a leading cause of morbidity and mortality affecting around 1.5 million patients per year in the United States 1 . Traumatic brain injury patients are at a high risk of developing deep vein thrombosis (DVT) and pulmonary embolism (PE) due to prolonged immobility, physiologic hypercoagulability, and delay to chemical venous thromboembolism (VTE) prophylaxis 2–4 . The development of VTE in TBI patients carries a two-fold increased risk of morbidity and mortality 5 …”

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confidence: 99%

A collaborative multidisciplinary trauma program improvement team improves VTE chemoprophylaxis guideline compliance in non-operative stable TBI

Al Tannir,

Golestani,

Tentis

et al. 2024

J Trauma Acute Care Surg

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Background Delays in initiating venous thromboembolism (VTE) prophylaxis in patients suffering from traumatic brain injury (TBI) persist despite guidelines recommending early initiation. We hypothesized that the expansion of a Trauma Program Performance Improvement (PI) team will improve compliance of early (24-48 hour) initiation of VTE prophylaxis and will decrease VTE events in TBI patients. Methods We performed a single-center retrospective review of all TBI patients admitted to a Level I trauma center before (2015-2016,) and after (2019-2020,) the expansion of the Trauma Performance Improvement and Patient Safety (PIPS) team and the creation of trauma process and outcome dashboards. Exclusion criteria included discharge or death within 48 hours of admission, expanding intracranial hemorrhage on CT scan, and a neurosurgical intervention (craniotomy, pressure monitor, or drains) prior to chemoprophylaxis initiation. Results A total of 1,112 patients met the inclusion criteria, of which 54% (n = 604) were admitted after Trauma PIPS expansion. Following the addition of a dedicated PIPS nurse in the trauma program and creation of process dashboards, the time from stable CT to VTE prophylaxis initiation decreased (52 hours to 35 hours; p < 0.001) and more patients received chemoprophylaxis at 24-48 hours (59% from 36%, p < 0.001) after stable head CT. There was no significant difference in time from first head CT to stable CT (9 vs 9 hours; p = 0.15). The Contemporary group had a lower rate of VTE events (1% vs 4%; p < 0.001) with no increase in bleeding events (2% vs 2%; p = 0.97). On multivariable analysis, being in the Early cohort was an independent predictor of VTE events (aOR: 3.74; 95%CI: 1.45-6.16). Conclusion A collaborative multidisciplinary Trauma PIPS team improves guideline compliance. Initiation of VTE chemoprophylaxis within 24-48 hours of stable head CT is safe and effective. Level of Evidence Level III, Therapeutic/Care Management

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Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry

Lombardo,

McCrum,

Knudson

et al. 2024

Trauma Surg Acute Care Open

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IntroductionOptimal venous thromboembolism (VTE) enoxaparin prophylaxis dosing remains elusive. Weight-based (WB) dosing safely increases anti-factor Xa levels without the need for routine monitoring but it is unclear if it leads to lower VTE risk. We hypothesized that WB dosing would decrease VTE risk compared with standard fixed dosing (SFD).MethodsPatients from the prospective, observational CLOTT-1 registry receiving prophylactic enoxaparin (n=5539) were categorized as WB (0.45–0.55 mg/kg two times per day) or SFD (30 mg two times per day, 40 mg once a day). Multivariate logistic regression was used to generate a predicted probability of VTE for WB and SFD patients.ResultsOf 4360 patients analyzed, 1065 (24.4%) were WB and 3295 (75.6%) were SFD. WB patients were younger, female, more severely injured, and underwent major operation or major venous repair at a higher rate than individuals in the SFD group. Obesity was more common among the SFD group. Unadjusted VTE rates were comparable (WB 3.1% vs. SFD 3.9%; p=0.221). Early prophylaxis was associated with lower VTE rate (1.4% vs. 5.0%; p=0.001) and deep vein thrombosis (0.9% vs. 4.4%; p<0.001), but not pulmonary embolism (0.7% vs. 1.4%; p=0.259). After adjustment, VTE incidence did not differ by dosing strategy (adjusted OR (aOR) 0.75, 95% CI 0.38 to 1.48); however, early administration was associated with a significant reduction in VTE (aOR 0.47, 95% CI 0.30 to 0.74).ConclusionIn young trauma patients, WB prophylaxis is not associated with reduced VTE rate when compared with SFD. The timing of the initiation of chemoprophylaxis may be more important than the dosing strategy. Further studies need to evaluate these findings across a wider age and comorbidity spectrum.Level of evidenceLevel IV, therapeutic/care management.

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Venous Thromboembolism Chemoprophylaxis in Trauma and Emergency General Surgery Patients: A Systematic Review

Cited by 4 publications

References 54 publications

Risk assessment scales to predict risk of lower extremity deep vein thrombosis among multiple trauma patients: A prospective cohort study

Risk assessment scales to predict risk of lower extremity deep vein thrombosis among multiple trauma patients: A prospective cohort study

A collaborative multidisciplinary trauma program improvement team improves VTE chemoprophylaxis guideline compliance in non-operative stable TBI

Weight-based enoxaparin thromboprophylaxis in young trauma patients: analysis of the CLOTT-1 registry

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