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World Journal of Surgery

Published in:

01-01-2007

Utility of Once-Daily Dose of Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism in Multisystem Trauma Patients

Authors: C. Clay Cothren, MD, Wade R. Smith, MD, Ernest E. Moore, MD, Steven J. Morgan, MD

Published in: World Journal of Surgery | Issue 1/2007

Abstract

Introduction

Venous thromboembolism is a preventable cause of death in the severely injured patient. Low-molecular-weight heparins (LMWHs) have been recommended as effective, safe prophylactic agents. However, LMWH use remains controversial in patients at risk for bleeding, those with traumatic brain injury, and those undergoing multiple invasive or operative procedures. We hypothesized that a protocol utilizing once-daily LMWH prophylaxis in high-risk trauma patients, regardless of the need for invasive procedures, is feasible, safe, and effective.

Methods

From August 1998 to August 2000, all patients admitted to our American College of Surgeons-verified Level I trauma facility following injury were evaluated for deep venous thrombosis (DVT) risk and prospectively followed. Patients at high risk for DVT, including those with stable intracranial injuries, were placed on our institutional protocol and prospectively followed. Patients on the protocol received daily injections of the LMWH, dalteparin; DVT screening was performed with duplex ultrasonography within 48 hours of admission and after 7 to 10 days after injury. Regimen compliance, bleeding complications, DVT rates, and pulmonary embolus (PE) rates were analyzed.

Results

During the 2-year study period, 6247 trauma patients were admitted; 743 were considered at high risk for DVT. Most of the patients were men (72%), with a mean age of 38.7 years (range 15–89 years) and a mean injury severity score (ISS) of 19.5. Compliance with the daily regimen was maintained in 74% of patients. DVT was detected in 3.9% and PE in 0.8%. The wound complications rate was 2.7%, and the need for unexplained transfusions was 3%. There were no exacerbations of head injury following dalteparin initiation due to bleeding. There were 16 patient deaths; none was caused by PE or late hemorrhage.

Conclusions

Once-daily dosing of prophylactic LMWH dalteparin is feasible, safe, and effective in high-risk trauma patients. Our protocol allows one to “operate through” systemic prophylaxis and ensures timely prophylaxis for brain-injured and multisystem trauma patients.

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Title: Utility of Once-Daily Dose of Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism in Multisystem Trauma Patients
Authors: C. Clay Cothren, MD
Wade R. Smith, MD
Ernest E. Moore, MD
Steven J. Morgan, MD
Publication date: 01-01-2007
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 1/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-006-0304-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Utility of Once-Daily Dose of Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism in Multisystem Trauma Patients

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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