Inability of an aggressive policy of thromboprophylaxis to prevent deep venous thrombosis (DVT) in critically injured patients

Are current methods of DVT prophylaxis insufficient?

George C. Velmahos, John Nigro, Raymond Tatevossian, James A. Murray, Edward E. Cornwell, Howard Belzberg, Juan A. Asensio, Thomas V. Berne, Demetrios Demetriades

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Background: Deep venous thrombosis (DVT) in severely injured patients is a life-threatening complication. Effective and safe thromboprophylaxis is highly desirable to prevent DVT. Low-dose heparin (LDH) and sequential compression device (SCDs) are the most frequently used methods. Inappropriate use of these methods because of the nature or site of critical injuries (eg, brain lesion, solid visceral or retroperitoneal hematoma, extremity fractures) may lead to failure of DVT prophylaxis. Study Design: A prospective study was performed to evaluate the efficacy of a policy of aggressive use of LDH and SCDs in patients who are at very high risk for DVT. From January 1996 to August 1997, 200 critically injured patients were followed by weekly Doppler examinations to detect DVT at the proximal lower extremities. Only 3 patients did not receive any thromboprophylaxis. SCDs were applied in 97.5% and LDH was administered to 46% of the patients; 45% had both. Results: DVT was found in 26 patients (13%). The majority (58%) developed DVT within the first 2 weeks, but new cases were found as late as 12 weeks after admission. The incidence of DVT was the same among patients who had SCDs only or a combination of LDH and SCDs. Mechanism of injury, type and number of operations, site of injury, Injury Severity Score, and the incidence of femoral lines were not different between patients with and without DVT. Differences were found in the severity of injury to the chest and the extremities and the need for high-level respiratory support. Patients with DVT had prolonged ICU and hospital stays (on average, 34 and 49 days, respectively) and a high mortality rate (31%). Conclusions: The incidence of DVT remains high among severely injured patients despite aggressive thromboprophylaxis. A combination of LDH and an SCD showed no advantage over SCD alone in decreasing DVT rates. Risk factors in this group of patients who are already at very high risk are hard to detect; Doppler examinations are justified for surveillance in all critically injured patients. Current methods of thromboprophylaxis seem to offer limited efficacy, and the search for more effective methods should continue.

Original languageEnglish
Pages (from-to)529-533
Number of pages5
JournalJournal of the American College of Surgeons
Volume187
Issue number5
DOIs
StatePublished - 1998
Externally publishedYes

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Venous Thrombosis
Equipment and Supplies
Heparin
Incidence
Extremities
Thoracic Injuries
Injury Severity Score
Wounds and Injuries
Thigh
Hematoma
Brain Injuries
Lower Extremity
Length of Stay
Prospective Studies
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Inability of an aggressive policy of thromboprophylaxis to prevent deep venous thrombosis (DVT) in critically injured patients : Are current methods of DVT prophylaxis insufficient? / Velmahos, George C.; Nigro, John; Tatevossian, Raymond; Murray, James A.; Cornwell, Edward E.; Belzberg, Howard; Asensio, Juan A.; Berne, Thomas V.; Demetriades, Demetrios.

In: Journal of the American College of Surgeons, Vol. 187, No. 5, 1998, p. 529-533.

Research output: Contribution to journalArticle

Velmahos, George C. ; Nigro, John ; Tatevossian, Raymond ; Murray, James A. ; Cornwell, Edward E. ; Belzberg, Howard ; Asensio, Juan A. ; Berne, Thomas V. ; Demetriades, Demetrios. / Inability of an aggressive policy of thromboprophylaxis to prevent deep venous thrombosis (DVT) in critically injured patients : Are current methods of DVT prophylaxis insufficient?. In: Journal of the American College of Surgeons. 1998 ; Vol. 187, No. 5. pp. 529-533.
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abstract = "Background: Deep venous thrombosis (DVT) in severely injured patients is a life-threatening complication. Effective and safe thromboprophylaxis is highly desirable to prevent DVT. Low-dose heparin (LDH) and sequential compression device (SCDs) are the most frequently used methods. Inappropriate use of these methods because of the nature or site of critical injuries (eg, brain lesion, solid visceral or retroperitoneal hematoma, extremity fractures) may lead to failure of DVT prophylaxis. Study Design: A prospective study was performed to evaluate the efficacy of a policy of aggressive use of LDH and SCDs in patients who are at very high risk for DVT. From January 1996 to August 1997, 200 critically injured patients were followed by weekly Doppler examinations to detect DVT at the proximal lower extremities. Only 3 patients did not receive any thromboprophylaxis. SCDs were applied in 97.5{\%} and LDH was administered to 46{\%} of the patients; 45{\%} had both. Results: DVT was found in 26 patients (13{\%}). The majority (58{\%}) developed DVT within the first 2 weeks, but new cases were found as late as 12 weeks after admission. The incidence of DVT was the same among patients who had SCDs only or a combination of LDH and SCDs. Mechanism of injury, type and number of operations, site of injury, Injury Severity Score, and the incidence of femoral lines were not different between patients with and without DVT. Differences were found in the severity of injury to the chest and the extremities and the need for high-level respiratory support. Patients with DVT had prolonged ICU and hospital stays (on average, 34 and 49 days, respectively) and a high mortality rate (31{\%}). Conclusions: The incidence of DVT remains high among severely injured patients despite aggressive thromboprophylaxis. A combination of LDH and an SCD showed no advantage over SCD alone in decreasing DVT rates. Risk factors in this group of patients who are already at very high risk are hard to detect; Doppler examinations are justified for surveillance in all critically injured patients. Current methods of thromboprophylaxis seem to offer limited efficacy, and the search for more effective methods should continue.",
author = "Velmahos, {George C.} and John Nigro and Raymond Tatevossian and Murray, {James A.} and Cornwell, {Edward E.} and Howard Belzberg and Asensio, {Juan A.} and Berne, {Thomas V.} and Demetrios Demetriades",
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AU - Nigro, John

AU - Tatevossian, Raymond

AU - Murray, James A.

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AU - Belzberg, Howard

AU - Asensio, Juan A.

AU - Berne, Thomas V.

AU - Demetriades, Demetrios

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