PURPOSE: The need to study methods of thromboembolism prophylaxis in high-risk trauma patients is well established. The purpose of this study was to evaluate the feasibility of a proposed study design, including current methods of prophylaxis, performance of a risk assessment profile scale, and the use of serial color-flow duplex studies in detecting deep venous thrombosis (DVT). METHODS: Patients were enrolled into the study, stratified as to their ability to receive anticoagulation and randomized to low-dose unfractionated heparin, low molecular weight heparin, pneumatic compression devices, or foot pumps with or without vena caval filters. Serial ultrasound scans were performed at designated intervals for 4 weeks. Pulmonary angiograms were obtained for clinical signs or symptoms of pulmonary embolism. RESULTS:Fifty-three patients, 32 male and 21 female patients with a mean age of 44 years, completed the study. The incidence of DVT was 43% (23 of 53 patients) and significantly higher in older patients. There were no pulmonary embolisms. Color-flow duplex proved to be a sensitive method for detecting both proximal and distal thrombi. The risk assessment profile for thromboembolism (RAPT) scale identified a group of patients with a high incidence of DVT. However, the occurrence of DVT was not correlated with the magnitude of the RAPT score. CONCLUSION: The ability to identify a population with a high incidence of thromboembolism by using the RAPT score to detect asymptomatic DVT, and the suggested advantage of low molecular weight heparin, all support the need for an appropriately powered randomized clinical trial.
RCT Entities:
PURPOSE: The need to study methods of thromboembolism prophylaxis in high-risk traumapatients is well established. The purpose of this study was to evaluate the feasibility of a proposed study design, including current methods of prophylaxis, performance of a risk assessment profile scale, and the use of serial color-flow duplex studies in detecting deep venous thrombosis (DVT). METHODS:Patients were enrolled into the study, stratified as to their ability to receive anticoagulation and randomized to low-dose unfractionated heparin, low molecular weight heparin, pneumatic compression devices, or foot pumps with or without vena caval filters. Serial ultrasound scans were performed at designated intervals for 4 weeks. Pulmonary angiograms were obtained for clinical signs or symptoms of pulmonary embolism. RESULTS: Fifty-three patients, 32 male and 21 female patients with a mean age of 44 years, completed the study. The incidence of DVT was 43% (23 of 53 patients) and significantly higher in older patients. There were no pulmonary embolisms. Color-flow duplex proved to be a sensitive method for detecting both proximal and distal thrombi. The risk assessment profile for thromboembolism (RAPT) scale identified a group of patients with a high incidence of DVT. However, the occurrence of DVT was not correlated with the magnitude of the RAPT score. CONCLUSION: The ability to identify a population with a high incidence of thromboembolism by using the RAPT score to detect asymptomatic DVT, and the suggested advantage of low molecular weight heparin, all support the need for an appropriately powered randomized clinical trial.
Authors: Simon Gabriel Rodier; Marko Bukur; Samantha Moore; Spiros George Frangos; Manish Tandon; Charles Joseph DiMaggio; Patricia Ayoung-Chee; Gary Thomas Marshall Journal: Eur J Trauma Emerg Surg Date: 2019-08-30 Impact factor: 3.693
Authors: Aniek Ag Zee; Kelly van Lieshout; Maaike van der Heide; Loes Janssen; Heinrich Mj Janzing Journal: Cochrane Database Syst Rev Date: 2017-08-06
Authors: Philipp Lichte; Philipp Kobbe; Khalid Almahmoud; Roman Pfeifer; Hagen Andruszkow; Frank Hildebrand; Rolf Lefering; Hans-Christoph Pape Journal: Int Orthop Date: 2015-02-18 Impact factor: 3.075
Authors: Jeffrey N Harr; Ernest E Moore; Theresa L Chin; Arsen Ghasabyan; Eduardo Gonzalez; Max V Wohlauer; Anirban Banerjee; Christopher C Silliman; Angela Sauaia Journal: J Trauma Acute Care Surg Date: 2013-03 Impact factor: 3.313