BACKGROUND: This retrospective review of a prospectively collected database was conducted to analyze the efficacy of 4 years of aggressive prophylaxis and screening protocols for venous thromboembolism (VTE) in a large population of trauma patients. METHODS: Trauma patients at a Level I Trauma Center found to be nonambulatory or otherwise high risk were placed on a protocol of lower-extremity (LE) compression devices and subcutaneous enoxaparin as soon as feasible after admission. Duplex scans of LEs were conducted weekly. RESULTS: During 4 years, 2,939 patients were admitted to trauma with length of stay >2 days. There was a 3.2% incidence of VTE in the length of stay >2 days population, 2.5% rate of deep venous thrombosis (DVT), and 0.7% pulmonary embolism. All VTE patients had factors known to increase risk of VTE and were included in our prophylaxis and screening protocol. Twenty-one percent of these received pharmacologic prophylaxis within the first 2 days of admission; 62% received enoxaparin at some point before diagnosis of VTE. Duplex scans were conducted in 982 patients. Notably, 86% of LE DVTs were found on routine screening duplex. CONCLUSION: To our knowledge, this is the largest population of trauma patients followed by screening duplexes. All patients with VTEs were identified as high risk, and screening revealed multiple patients with an asymptomatic DVT. We conclude our aggressive prophylaxis regimen lead to low rates of VTE and think screening duplex is a critical component for identifying unsuspected DVT.
BACKGROUND: This retrospective review of a prospectively collected database was conducted to analyze the efficacy of 4 years of aggressive prophylaxis and screening protocols for venous thromboembolism (VTE) in a large population of traumapatients. METHODS:Traumapatients at a Level I Trauma Center found to be nonambulatory or otherwise high risk were placed on a protocol of lower-extremity (LE) compression devices and subcutaneous enoxaparin as soon as feasible after admission. Duplex scans of LEs were conducted weekly. RESULTS: During 4 years, 2,939 patients were admitted to trauma with length of stay >2 days. There was a 3.2% incidence of VTE in the length of stay >2 days population, 2.5% rate of deep venous thrombosis (DVT), and 0.7% pulmonary embolism. All VTEpatients had factors known to increase risk of VTE and were included in our prophylaxis and screening protocol. Twenty-one percent of these received pharmacologic prophylaxis within the first 2 days of admission; 62% received enoxaparin at some point before diagnosis of VTE. Duplex scans were conducted in 982 patients. Notably, 86% of LE DVTs were found on routine screening duplex. CONCLUSION: To our knowledge, this is the largest population of traumapatients followed by screening duplexes. All patients with VTEs were identified as high risk, and screening revealed multiple patients with an asymptomatic DVT. We conclude our aggressive prophylaxis regimen lead to low rates of VTE and think screening duplex is a critical component for identifying unsuspected DVT.
Authors: Daniel W Nelson; Vlad V Simianu; Amir L Bastawrous; Richard P Billingham; Alessandro Fichera; Michael G Florence; Eric K Johnson; Morris G Johnson; Richard C Thirlby; David R Flum; Scott R Steele Journal: JAMA Surg Date: 2015-08 Impact factor: 14.766
Authors: Yaseen M Arabi; Karen E A Burns; Sami J Alsolamy; Mohammed S Alshahrani; Fahad M Al-Hameed; Zia Arshad; Mohammed Almaani; Hassan Hawa; Yasser Mandourah; Ghaleb A Almekhlafi; Abdulsalam Al Aithan; Imran Khalid; Jalal Rifai; Gulam Rasool; Sheryl Ann I Abdukahil; Jesna Jose; Lara Y Afesh; Abdulaziz Al-Dawood Journal: Intensive Care Med Date: 2020-02-24 Impact factor: 17.440
Authors: Ajai K Malhotra; Stephanie R Goldberg; Laura McLay; Nancy R Martin; Luke G Wolfe; Mark M Levy; Vishal Khiatani; Todd C Borchers; Therese M Duane; Michel B Aboutanos; Rao R Ivatury Journal: PLoS One Date: 2014-09-30 Impact factor: 3.240
Authors: Yaseen M Arabi; Karen E A Burns; Fahad Al-Hameed; Sami Alsolamy; Mohammed Almaani; Yasser Mandourah; Ghaleb A Almekhlafi; Ali Al Bshabshe; Mohammed Alshahrani; Imran Khalid; Hassan Hawa; Zia Arshad; Hani Lababidi; Abdulsalam Al Aithan; Jesna Jose; Sheryl Ann I Abdukahil; Lara Y Afesh; Abdulaziz Al-Dawood Journal: Medicine (Baltimore) Date: 2018-09 Impact factor: 1.817
Authors: Lloyd Roberts; Tom Rozen; Deirdre Murphy; Adam Lawler; Mark Fitzgerald; Harry Gibbs; Kyle Brooks; Joshua F Ihle; Tim Leong; Judit Orosz; Eldho Paul; Vinodh Bhagyalakshmi Nanjayya Journal: Ann Intensive Care Date: 2020-09-14 Impact factor: 6.925