Venous thromboembolism risk after spinal cord injury: A secondary analysis of the CLOTT study

Godat, Laura N; Haut, Elliott R.; Moore, Ernest E.; Knudson, M. Margaret; Costantini, Todd W.

doi:10.1097/ta.0000000000003807

Cited by 14 publications

(13 citation statements)

References 36 publications

(78 reference statements)

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“…Even when best-practice prophylaxis is prescribed to trauma patients, nonadministration of regular pharmacologic prophylaxis may limit their effectiveness. Numerous studies have shown the association of VTE events with missed doses of VTE prophylaxis 7,8,38,39 . We must continuously strive for all steps of defect-free care to include evidence-based risk assessment, prescription of optimal prophylaxis, and administration of all prescribed doses of prophylaxis 31 .…”

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confidence: 99%

“…Numerous studies have shown the association of VTE events with missed doses of VTE prophylaxis. 7,8,38,39 We must continuously strive for all steps of defect-free care to include evidence-based risk assessment, prescription of optimal prophylaxis, and administration of all prescribed doses of prophylaxis. 31 Missed of VTE prophylaxis have been commonly identified at large academic hospitals (including trauma centers), as well as community hospitals.…”

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confidence: 99%

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Implementation science approaches to optimizing venous thromboembolism prevention in patients with traumatic injuries: Findings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma

Ratnasekera

Geerts

Haut

et al. 2022

J Trauma Acute Care Surg

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Disease burden of venous thromboembolism (VTE) without pharmacologic prophylaxis is high in trauma patients. Although VTE prophylaxis guidelines exist, studies on real-world use of VTE prophylaxis in trauma shows limited uptake of guideline recommendations. Despite existing guidelines, reports indicate that VTE prophylaxis implementation across trauma centers is lagging. Implementation barriers of VTE prophylaxis in trauma are multifactorial, and VTE prescribing practices require further optimization. Implementation science methods can help standardize and improve care; well-established approaches in medical and surgical hospitalized patients and their effects on clinical outcomes such as VTE and bleeding complications must be investigated because they apply to trauma patients. Nonadministration of VTE prophylaxis medications in hospitalized patients is associated with VTE events and remains a barrier to providing optimal defect-free care. Further investigations are required for VTE prophylaxis implementation across all trauma populations.

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confidence: 99%

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confidence: 99%

Implementation science approaches to optimizing venous thromboembolism prevention in patients with traumatic injuries: Findings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma

Ratnasekera

Geerts

Haut

et al. 2022

J Trauma Acute Care Surg

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“…Secondary analysis of the Consortium Leaders in the Study of Traumatic Thromboembolism (CLOTT) trial indicated improved VTE events in spinal cord injuries with early use of LMWH. 13 Applying the results of the CLOTT trial which was primarily comprised of young patients (mean age = 29.0 years) may be challenging at other trauma centers. 14 For example, the traumatic spine surgery practice at MMC with older patient population is oriented toward early UFH use.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Protocol-Driven Venous Thromboembolic Chemo-Prophylaxis in Trauma Patients: A Trauma Quality Improvement Project Analysis

Kyros,

Sheppard,

Sawhney

et al. 2023

The American Surgeon™

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Introduction Low molecular weight heparin (LMWH) is the standard for venous thromboembolic (VTE) chemo-prophylaxis in trauma patients; however, inconsistencies in the use of LMWH exist. The objective of this study was to assess VTE outcomes in response to a chemo-prophylaxis protocol guided by patient physiology (eg, creatinine clearance) and comorbidities. Methods ACS TQIP Benchmark Reports at a level 1 trauma center using a patient physiology and comorbidity directed VTE chemo-prophylaxis protocol were analyzed for Spring 2019 to Fall 2021. Patient demographics, VTE rates and pharmacologic VTE prophylaxis type were collected for “All Patients” and “Elderly” (TQIP: age ≥ 55 years) cohorts. Results Data was analyzed for 1919183 “All Hospitals” (AH) and 5843 patients single institution (SI) using the physiologic and comorbidity guided VTE chemo-prophylaxis protocol. Elderly subgroup had 701965 (AH) and 2939 (SI) patients. Use of non-LMWH chemo-prophylaxis was significantly higher at SI: All patients = 62.6% SI vs 22.1% ( P < .01); Elderly = 68.8% SI vs 28.1% AH ( P < .01). VTE, DVT, and PE rates for All Patients and Elderly subgroup were significantly reduced at SI, except Elderly PE which was statistically equivalent. Conclusions Protocol-driven VTE chemo-prophylaxis was associated with significantly lower LMWH use accompanied by significant reductions in All VTE, DVT, PE, and Elderly VTE and DVT with no difference in Elderly PE rates. These results may imply that adherence to a physiologic and comorbidity directed chemo-prophylaxis protocol, rather than LMWH, reduces VTE events in trauma patients. Further investigation to elucidate best practice is warranted.

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“…Both societies emphasize that thromboprophylaxis should be continuous and without interruption. Missed doses of VTE prophylaxis are significantly associated with increased risk of VTE 59,60 . Furthermore, the practice of holding pharmacologic prophylaxis for surgical procedures out of fear of bleeding complication is not based on evidence.…”

Section: Current Guidelines For Optimal Vte Prophylaxis After Traumamentioning

confidence: 99%

“…Missed doses of VTE prophylaxis are significantly associated with increased risk of VTE. 59,60 Furthermore, the practice of holding pharmacologic prophylaxis for surgical procedures out of fear of bleeding complication is not based on evidence. In Geerts' 1996 landmark trial, prophylaxis was not withheld for surgical procedures except for spinal fixation (for which only one preoperative dose was held).…”

Section: Missed Doses Of Pharmacologic Vte Prophylaxismentioning

confidence: 99%

Proceedings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma

Haut¹,

Byrne²,

Price³

et al. 2022

J Trauma Acute Care Surg

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On May 4 and 5, 2022, a meeting of multidisciplinary stakeholders in the prevention and treatment of venous thromboembolism (VTE) after trauma was convened by the Coalition for National Trauma Research, funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health, and hosted by the American College of Surgeons in Chicago, Illinois. This consensus conference gathered more than 40 in-person and 80 virtual attendees, including trauma surgeons, other physicians, thrombosis experts, nurses, pharmacists, researchers, and patient advocates. The objectives of the meeting were twofold: (1) to review and summarize the present state of the scientific evidence regarding VTE prevention strategies in injured patients and (2) to develop consensus on future priorities in VTE prevention implementation and research gaps. To achieve these objectives, the first part of the conference consisted of talks from physician leaders, researchers, clinical champions, and patient advocates to summarize the current state of knowledge of VTE pathogenesis and prevention in patients with major injury. Video recordings of all talks and accompanying slides are freely available on the conference website (https://www.nattrauma.org/research/research-policies-templatesguidelines/vte-conference/). Following this curriculum, the second part of the conference consisted of a series of small-group breakout sessions on topics potentially requiring future study. Through this process, research priorities were identified, and plans of action to develop and undertake future studies were defined. The 2022 Consensus Conference to Implement Optimal VTE Prophylaxis in Trauma answered the National Trauma Research Action Plan call to define a course for future research into preventing thromboembolism after trauma. A multidisciplinary group of clinical champions, physicians, scientists, and patients delineated clear objectives for future investigation to address important, persistent key knowledge gaps. The series of papers from the conference outlines the consensus based on the current literature and a roadmap for research to answer these unanswered questions.

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Venous thromboembolism risk after spinal cord injury: A secondary analysis of the CLOTT study

Abstract: Spinal cord injury patients are at high risk of VTE. Early initiation of prophylaxis is associate with lower VTE rates. Delayed initiation of prophylaxis, heparin, and missed doses are associated with increased risk of VTE and represent targets for quality improvement measures.

Cited by 14 publications

References 36 publications

Implementation science approaches to optimizing venous thromboembolism prevention in patients with traumatic injuries: Findings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma

Implementation science approaches to optimizing venous thromboembolism prevention in patients with traumatic injuries: Findings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma

Outcomes of Protocol-Driven Venous Thromboembolic Chemo-Prophylaxis in Trauma Patients: A Trauma Quality Improvement Project Analysis

Proceedings from the 2022 Consensus Conference to Implement Optimal Venous Thromboembolism Prophylaxis in Trauma

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