Title

Four Years of an Aggressive Prophylaxis and Screening Protocol for Venous Thromboembolism in a Large Trauma Population

Document Type

Presentation

Publication Date

9-29-2007

Abstract

Purpose: This retrospective review of a prospectively collected database was conducted to determine the efficacy of four years of an aggressive screening and prophylaxis protocol for venous thromboembolism (VTE) in a large trauma population.

Methods: From Oct 2002 to Sept 2006, high-risk trauma patients received prophylaxis with both lower extremity (LE) mechanical compression and low molecular weight heparin after admission and were followed with weekly LE duplex ultrasound studies. Data were acquired from the trauma registry for patients with length of stay (LOS) >2 days and adjunctive chart review conducted in all patients with VTE.

Results: Over 4 years, 2,939 patients were admitted to the Trauma service with LOS >2 days. Overall rates for deep venous thrombosis (DVT) and pulmonary embolus (PE) were 2.5% and 0.7%. High risk criteria of closed head injury, spinal cord injury, LE fractures, and pelvic fractures were present in 89% of VTEs. Duplex ultrasound was performed in 982 patients, 9% with DVTs. Notably, 85% of LE DVTs were found on screening duplex.

Conclusions: Routine use of both mechanical compression and pharmacologic prophylaxis in patients meeting defined high risk criteria leads to a very low incidence of VTE when compared to the literature. All patients with VTEs were identified as high risk by our expanded criterion, and the weekly screenings revealed multiple DVTs clinically silent at the time of diagnosis. The use of weekly screening duplexes in this large group provides the denominator to confirm the efficacy of an aggressive approach.

Sponsorship/Conference/Institution

American Association for the Surgery of Trauma Annual Conference (AAST)

Location

Las Vegas, NV