Venous thromboembolism in trauma: a local manifestation of systemic hypercoagulability?
BACKGROUND
The purpose of this study was to evaluate the relative importance of systemic hypercoagulability, preexisting and acquired risk factors, and specific injury patterns in the development of venous thromboembolism (VTE) after injury.


METHODS
Injured patients with an Injury Severity Score > or = 15 were followed with lower extremity venous duplex ultrasonography, prothrombin fragment 1 + 2, and quantitative D-dimer levels at 1 and 3 days and then weekly until discharge.


RESULTS
Among 101 patients with a mean Injury Severity Score of 27.3 +/- 10.5 followed for 12.4 +/- 8.7 days, 28 (27.7%) developed a lower extremity thrombosis, 2 (1.9%) sustained a pulmonary embolism, and 1 (0.9%) had a symptomatic upper extremity thrombosis. Although admission fragment 1 + 2 and D-dimer levels were elevated in 81.4% and 100% of patients, respectively, mean levels were not significantly different in those with or without VTE. VTE was more common (p < 0.05) among those with obesity, age > 40 years, immobilization for > 3 days, spine fractures, and lower extremity fractures. However, only obesity (p = 0.004) and immobilization > 3 days (p = 0.05) were independent predictors of VTE in a multivariate analysis.


CONCLUSIONS
Although elevated in seriously injured patients, neither markers of activated coagulation nor specific injury patterns are predictive of VTE. Associations with immobilization and obesity suggest that VTE after injury is a systemic hypercoagulable disorder with local manifestations of thrombosis related to lower extremity stasis.
Meissner
Mark H
MH
Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, 98195, USA. meissner@u.washington.edu
Chandler
Wayne L
WL
Elliott
Jennifer S
JS
D000328:Adult; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000150:complications; D011446:Prospective Studies; D012307:Risk Factors; D019851:Thrombophilia / Q000150:complications*; D015599:Trauma Severity Indices; D020246:Venous Thrombosis / Q000209:etiology*; D014947:Wounds and Injuries / Q000145:classification* / Q000150:complications
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D