scholarly journals 1558: REDUCTION OF VENOUS THROMBOEMBOLISM IN TRAUMA PATIENTS WITH TARGETED ENOXAPARIN DOSE ADJUSTMENT

2021 ◽  
Vol 50 (1) ◽  
pp. 783-783
Author(s):  
Saamia Shaikh ◽  
Robert Madlinger ◽  
Benjamin Rebein ◽  
Melissa Warta ◽  
Jamshed Zuberi
Keyword(s):  
Venous Thromboembolism ◽  
Dose Adjustment ◽  
Trauma Patients

Venous thromboembolism in a general hospital. An update with low molecular weight heparin prophylaxis

VASA ◽  
2007 ◽  
Vol 36 (1) ◽  
pp. 17-22
Author(s):  
Schulz ◽  
Kesselring ◽  
Seeberger ◽  
Andresen
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Low Molecular Weight ◽  
Trauma Patients ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Patients At Risk ◽  
Hospital Stays ◽  
Event Rates

Background: Patients admitted to hospital for surgery or acute medical illnesses have a high risk for venous thromboembolism (VTE). Today’s widespread use of low molecular weight heparins (LMWH) for VTE prophylaxis is supposed to have reduced VTE rates substantially. However, data concerning the overall effectiveness of LMWH prophylaxis is sparse. Patients and methods: We prospectively studied all patients with symptomatic and objectively confirmed VTE seen in our hospital over a three year period. Event rates in different wards were analysed and compared. VTE prophylaxis with Enoxaparin was given to all patients at risk during their hospital stay. Results: A total of 50 464 inpatients were treated during the study period. 461 examinations were carried out for symptoms suggestive of VTE and yielded 89 positive results in 85 patients. Seventy eight patients were found to have deep vein thrombosis, 7 had pulmonary embolism, and 4 had both deep venous thrombosis and pulmonary embolism. The overall in hospital VTE event rate was 0.17%. The rate decreased during the study period from 0.22 in year one to 0,16 in year two and 0.13 % in year three. It ranged highest in neurologic and trauma patients (0.32%) and lowest (0.08%) in gynecology-obstetrics. Conclusions: With a simple and strictly applied regimen of prophylaxis with LMWH the overall rate of symptomatic VTE was very low in our hospitalized patients. Beside LMWH prophylaxis, shortening hospital stays and substantial improvements in surgical and anasthesia techniques achieved during the last decades probably play an essential role in decreasing VTE rates.

Determining the impact of culture on venous thromboembolism prevention in trauma patients: A Southwestern Surgical Congress Multicenter trial

2019 ◽  
Vol 217 (6) ◽  
pp. 1030-1036 ◽  
Author(s):  
Justin L. Regner ◽  
Courtney N. Shaver ◽  
Richard Frazee ◽  
Steven E. Brooks ◽  
Sharmila Dissanaike ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Multicenter Trial ◽  
Trauma Patients ◽  
Venous Thromboembolism Prevention ◽  
The Impact

Venous Thromboembolism in Trauma Patients

2007 ◽  
Vol 73 (11) ◽  
pp. 1173-1180 ◽  
Author(s):  
Om P. Sharma ◽  
Michael F. Oswanski ◽  
Rusin J. Joseph ◽  
Peter Tonui ◽  
Libby Westrick Pa-C ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thromboembolism ◽  
Injury Severity Score ◽  
Severity Score ◽  
Injury Severity ◽  
Univariate Analysis ◽  
Trauma Patients ◽  
Vein Thrombosis ◽  
Cord Injury ◽  
Deep Vein

Serial venous duplex scans (VDS) were done in 507 trauma patients with at least one risk factor (RF) for venous thromboembolism (VTE) during a 2-year study period. Deep vein thrombosis (DVT) was detected in 31 (6.1%) patients. This incidence was 3.1 per cent in low (1–2 RFs), 3.4 per cent in moderate (3–5 RFs), and 7.7 per cent in high (≥6 RFs) VTE scores ( P = 0.172). Incidence was statistically different (3% vs 7.2%, P = 0.048) on reanalyzing patients in two risk categories, low-risk (1–4 RFs) and high-risk (≥5 RFs). Only 4 of 16 RFs had statistically higher incidence of DVT in patients with or without RFs: previous VTE (27.3% vs 5.6%, odds ratio (OR) 6.628, P = 0.024), spinal cord injury (22.6% vs 5%, OR 5.493, P = 0.001), pelvic fractures (11.4% vs 5.1%, OR 2.373, P = 0.042), and head injury with a greater than two Abbreviated Injury Score (10.5% vs 4.2%, OR 2.639, P = 0.014). On reanalyzing patients with ≥5 RFs vs <5RFs, obesity (14.3 vs 6.1%, P = 0.007), malignancy (5.6% vs 0.6%, P = 0.006), coagulopathy (10.8% vs 1.8%, P = 0.000), and previous VTE (3.2% vs 0%, P = 0.019) were significant on univariate analysis. Patients with DVT had 3.70 ± 1.75 RFs and a 9.61 ± 4.93 VTE score, whereas, patients without DVT had 2.66 ± 1.50 RFs and a 6.83 ± 3.91 VTE score ( P = 0.000). DVTs had a direct positive relationship with higher VTE scores, length of stay, and number of VDS (>1 r, P ≤ 0.001). Increasing age was a weak risk factor (0.03 r, P = 0.5). First two VDS diagnosed 77 per cent of DVTs. Patients with injury severity score of ≥15 and 25 had higher DVTs compared with the ones with lower injury severity score levels ( P ≤ 0.05). Pulmonary embolism was silent in 63 per cent and DVTs were asymptomatic in 68 per cent.

Massive Transfusion Protocol and Subsequent Development of Venous Thromboembolism: Statewide Analysis

2020 ◽  
pp. 000313482094890
Author(s):  
Eric H. Bradburn ◽  
Kwok M. Ho ◽  
Madison E. Morgan ◽  
Lauren D’Andrea ◽  
Tawnya M. Vernon ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Injury Severity ◽  
Massive Transfusion ◽  
Subsequent Development ◽  
Multivariate Logistic Regression Model ◽  
Trauma Patients ◽  
Vte Prophylaxis ◽  
Vein Thrombosis ◽  
Hemorrhagic Event ◽  
High Index Of Suspicion

Background Massive transfusion protocols (MTP) are a routine component of any major trauma center’s armamentarium in the management of exsanguinating hemorrhages. Little is known about the potential complications of those that survive a MTP. We sought to determine the incidence of venous thromboembolism (VTE) following MTP. We hypothesized that MTP would be associated with a higher risk of VTE when compared with a risk-adjusted control population without MTP. Methods The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2015 to 2018 for trauma patients who developed VTE and survived until discharge at accredited trauma centers in Pennsylvania. Patient demographics, injury severity, and clinical outcomes were compared to assess differences in VTE development between MTP and non-MTP patients. A multivariate logistic regression model assessed the adjusted impact of MTP on VTE development. Results 176 010 patients survived until discharge, meeting inclusion criteria. Of those, 1667 developed a VTE (pulmonary embolism [PE]: 662 [0.4%]; deep vein thrombosis [DVT]: 1142 [0.6%]; PE and DVT: 137 [0.1%]). 1268 patients (0.7%) received MTP and, of this subset of patients, 171 (13.5%) developed a VTE during admission. In adjusted analysis, patients who had a MTP and survived until discharge had a higher odds of developing a VTE (adjusted odds ratio: 2.62; 95% CI: 2.13-3.24; P < .001). Discussion MTP is a harbinger for higher risk of VTE in those patients who survive. This may, in part, be related to the overcorrection of coagulation deficits encountered in the hemorrhagic event. A high index of suspicion for the development of VTE as well as aggressive VTE prophylaxis is warranted in those patients who survive MTP.

Contact isolation is a risk factor for venous thromboembolism in trauma patients

2015 ◽  
Vol 79 (5) ◽  
pp. 833-837 ◽  
Author(s):  
Christopher R. Reed ◽  
Robert A. Ferguson ◽  
Yiming Peng ◽  
Bryan R. Collier ◽  
Eric H. Bradburn ◽  
...  
Keyword(s):  
Risk Factor ◽  
Venous Thromboembolism ◽  
Trauma Patients ◽  
Contact Isolation

Prediction of venous thromboembolism using clinical and serum biomarker data from a military cohort of trauma patients

2020 ◽  
pp. bmjmilitary-2019-001393 ◽  
Author(s):  
Matthew Bradley ◽  
A Shi ◽  
V Khatri ◽  
S Schobel ◽  
E Silvius ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Injury Severity ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Area Under The Curve ◽  
Serum Biomarkers ◽  
Trauma Patients ◽  
Total Blood ◽  
Mortality And Morbidity ◽  
Clinical Measures

IntroductionVenous thromboembolism (VTE) is a frequent complication of trauma associated with high mortality and morbidity. Clinicians lack appropriate tools for stratifying trauma patients for VTE, thus have yet to be able to predict when to intervene. We aimed to compare random forest (RF) and logistic regression (LR) predictive modelling for VTE using (1) clinical measures alone, (2) serum biomarkers alone and (3) clinical measures plus serum biomarkers.MethodsData were collected from 73 military casualties with at least one extremity wound and prospectively enrolled in an observational study between 2007 and 2012. Clinical and serum cytokine data were collected. Modelling was performed with RF and LR based on the presence or absence of deep vein thrombosis (DVT) and/or pulmonary embolism (PE). For comparison, LR was also performed on the final variables from the RF model. Sensitivity/specificity and area under the curve (AUC) were reported.ResultsOf the 73 patients (median Injury Severity Score=16), nine (12.3%) developed VTE, four (5.5%) with DVT, four (5.5%) with PE, and one (1.4%) with both DVT and PE. In all sets of predictive models, RF outperformed LR. The best RF model generated with clinical and serum biomarkers included five variables (interleukin-15, monokine induced by gamma, vascular endothelial growth factor, total blood products at resuscitation and presence of soft tissue injury) and had an AUC of 0.946, sensitivity of 0.992 and specificity of 0.838.ConclusionsVTE may be predicted by clinical and molecular biomarkers in trauma patients. This will allow the development of clinical decision support tools which can help inform the management of high-risk patients for VTE.

scholarly journals Admission thrombelastography does not guide dose adjustment of enoxaparin in trauma patients

2020 ◽  
Vol 2 (4) ◽  
pp. 41-44
Author(s):  
Hannah V. Hayes ◽  
Molly E. Droege ◽  
Craig J. Furnish ◽  
Michael D. Goodman ◽  
Neil E. Ernst ◽  
...  
Keyword(s):  
Dose Adjustment ◽  
Trauma Patients

ABO blood group as a potential risk factor for venous thromboembolism in acutely injured patients

2011 ◽  
Vol 105 (01) ◽  
pp. 5-13 ◽  
Author(s):  
Sarah Muellner ◽  
Elliott Haut ◽  
Michael Streiff ◽  
John Holcomb ◽  
Bryan Cotton
Keyword(s):  
Risk Factor ◽  
Venous Thromboembolism ◽  
Blood Group ◽  
Abo Blood Group ◽  
Trauma Patients ◽  
Major Health Problem ◽  
Increase Risk ◽  
Significant Burden ◽  
Injured Patients ◽  
Von Willebrand

SummaryVenous thromboembolism (VTE) is a major health problem that results in a significant burden on hospitals and patients. VTE screening and prophylaxis protocols in trauma patients vary significantly among hospitals and providers. In addition, many patients develop VTE even in the absence of “high-risk” categories. Therefore, more research is needed to better understand and prevent VTE in these patients. ABO blood group has long been recognised as a risk factor for VTE, but its contribution to VTE risk in the trauma setting is poorly studied. This paper reviews the literature describing the link between ABO blood group and VTE risk and the implications for VTE screening and prophylaxis in trauma patients. The effect of ABO blood groups are genotype-dependent – in most populations the A1 allele and the B allele increase risk while A2, O1, and O2 decrease risk of VTE. ABO group is a major determinant of plasma von Willebrand factor (vWF) and factor VIII levels, thereby (partially) mediating the effects of ABO blood group on VTE susceptibility. In addition, ABH antigens alter plasma levels of vWF via clearance mechanisms, which are in turn mediated by ADAMTS13. ABO blood group is a risk factor for VTE that warrants further investigation in trauma patients.

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