Efficacy of subcutaneous heparin in prevention of venous thromboembolic events in trauma patients.
Trauma patients have an incidence of deep venous thrombosis (DVT) of 7% to 65%. Conflicting data exists regarding the impact of prophylactic anticoagulant therapy. The purpose of this study is to assess the efficacy of DVT prophylaxis based upon our data and a meta-analysis of the current literature. Literature review revealed five recent studies that met the following criteria: 1) Adult patients sustaining major trauma (injury severity score (ISS) > 10), 2) prospective surveillance for DVT using lower extremity duplex examinations, 3) clear documentation of method of DVT prophylaxis with particular attention to the use of anticoagulation and the corresponding incidence of DVT or pulmonary embolus (PE). Additionally, 66 trauma patients in our intensive care unit were prospectively identified and followed with duplex examinations. Patients received either anticoagulation DVT prophylaxis or pneumatic compression boots. An unpaired Student t test was used to compare the characteristics of patients with and without DVT. A Mantel-Haenszel chi-square meta-analysis was performed on the five recent studies and our own data to compare the incidence of DVT/PE in patients with and without anticoagulation. Meta-analysis of the literature included 1102 patients and demonstrated no benefit from anticoagulation for DVT prophylaxis in trauma patients (10% DVT/PE with anticoagulation versus 7 per cent DVT/PE without anticoagulation, P = 0.771). Our own population had a mean age of 38 +/- 17 years, ISS of 29 +/- 11 and a length of stay (LOS) of 34 +/- 22 days. Sixteen events occurred with 13 (20%) DVTs and three (4%) pulmonary emboli.(ABSTRACT TRUNCATED AT 250 WORDS)
Upchurch
G R
GR
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Demling
R H
RH
Davies
J
J
Gates
J D
JD
Knox
J B
JB
D000328:Adult; D000367:Age Factors; D005676:Gravity Suits; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007279:Injections, Subcutaneous; D008875:Middle Aged; D013923:Thromboembolism / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications*
D006493:Heparin