Venous thromboembolism after trauma.
OBJECTIVE
The trauma population is at increased risk of venous thromboembolic disease, a potentially preventable cause of mortality and morbidity. Although the association between trauma and venous thromboembolism has been recognized for more than a century, there is still great variability in the clinical practices with respect to prophylaxis. This thorough review of recent literature aims to clarify the incidence and risk factors for deep venous thrombosis and pulmonary embolism after trauma, review options and recommendations for detection of deep venous thrombosis and pulmonary embolism, and give evidence-based recommendations for prophylaxis. Special attention is paid to patients with spinal cord injury, patients with head injury, and pediatric trauma patients.


RESULTS
Highlights in this field during the past year include stratification of venous thromboembolism risk factors after trauma using a large national database, the expanded use of venous duplex ultrasound surveillance in the ICU and during rehabilitation, and investigations into the safety of low molecular weight heparins in patients with solid organ and traumatic brain injuries. Additionally, two new classes of anticoagulant drugs have been introduced for venous thromboembolism prophylaxis, and there are some preliminary studies on a temporary vena cava filter for the prevention of pulmonary embolism.


CONCLUSIONS
Venous thromboembolism remains an area of active clinical research focusing on evolving diagnostic techniques, newer methods of chemical and mechanical prophylaxis, and improved understanding of the etiologic factors of posttraumatic venous thromboembolism. These efforts will undoubtedly decrease the posttraumatic morbidity and mortality associated with venous thromboembolism.
Knudson
M Margaret
MM
Department of Surgery, University of California, San Francisco, California 94110, USA. pknudson@sfghsurg.ucsf.edu
Ikossi
Danagra G
DG
D000465:Algorithms; D001777:Blood Coagulation; D002986:Clinical Trials as Topic; D006801:Humans; D016017:Odds Ratio; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D012307:Risk Factors; D013923:Thromboembolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D014947:Wounds and Injuries / Q000150:complications* / Q000628:therapy