[Venous thrombosis following severe multiple trauma].
The incidence of thromboembolic complications in patients with multiple injuries was reviewed as well with respect to our own prospective investigation (141 patients with a mean injury severity score of 37 points). The rate of deep venous thrombosis (DVT) in severely injured patients is reported to vary from 20 to 90% if invasive diagnostic procedures are used, whereas the rate of clinically relevant manifestations of DVT seems to be much lower. Although 96% of the patient population in our study were thought to be at high risk of having DVT (applying generally accepted risk factors), only 1.4% of the subjects actually developed clinically relevant DVT. The analysis of several parameters of the coagulation and fibrinolytic systems (platelet count, prothrombin time, partial thromboplastin time, antithrombin III, prothrombin, plasminogen, tissue-plasminogen-activator and its inhibitor) showed simultaneous activation of both systems in these severely injured patients. Thus, increased coagulation seems to be counteracted by increased fibrinolysis. In addition, fluid resuscitation with crystalloid and colloid infusions in the prehospital period (1970 ml and 573 ml, respectively) can be viewed as early prophylaxis of thromboembolic complications. Thus, the low DVT rate in a high-risk patient group with multiple injuries might be at least partially explained.
Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München.
D
D
Nast-Kolb
C
C
Waydhas
C
C
Kerim-Sade
M
M
Jochum
M
M
Spannagl
D000328:Adult; D001780:Blood Coagulation Tests; D005260:Female; D005342:Fibrinolysis; D005440:Fluid Therapy; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000145:classification / Q000503:physiopathology*; D015849:Plasminogen Inactivators / Q000032:analysis; D011446:Prospective Studies; D012307:Risk Factors; D013924:Thrombophlebitis / Q000503:physiopathology* / Q000517:prevention & control; D010959:Tissue Plasminogen Activator / Q000032:analysis
D015849:Plasminogen Inactivators; D010959:Tissue Plasminogen Activator
Venöse Thrombosen nach schweren Mehrfachverletzungen.