title: A survey of thromboprophylaxis management in patients with major trauma.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is a common life-threatening complication of major trauma. Although clinical guidelines clearly suggest routine VTE prevention with low-molecular-weight heparin (LMWH) in this specific group of patients, there is still a lack of strong recommendations regarding the timing and the modality of heparin administration and the role of mechanical prophylaxis. We tested the hypothesis that there is significant practice variation in thromboprophylaxis management of patients with major trauma among intensive care unit (ICU) specialists.
  
  
  METHODS
  Two hundred Italian ICU specialists, representing 200 ICU throughout the country, were contacted by telephone and were asked (1) whether they routinely prescribe pharmacological antithrombotic prophylaxis in patients with major trauma, whether prophylaxis is prescribed to all patients or to selected patients, and the type of prophylaxis and the timing of administration and (2) whether they recommend physical prevention, whether this is prescribed to all patients or to selected patients, and the type of physical prophylaxis.
  
  
  RESULTS
  In patients with major trauma, 85% of the interviewed ICU specialists answered that they prescribe pharmacological prophylaxis for VTE. 37.6% of them prescribe prophylaxis only to selected patients based on the level of risk, 87.7% prescribe low-molecular-weight heparin, and 42.4% start prophylaxis immediately after hospitalization. Only 61% of the interviewed specialists prescribe physical prophylaxis; 82.8% of them use elastic stockings, 9.8% intermittent pneumatic compression, and 7.4% other mechanical devices. Physical prophylaxis is prescribed to all patients by 41%, and by 59% only in case of contraindication to pharmacological prevention. Inferior vena cava (IVC) filter insertion is considered by 47% when anticoagulation is contraindicated; 91.4% of them recommend the IVC filter only if deep vein thrombosis (DVT) has been diagnosed.
  
  
  CONCLUSIONS
  Even when there are clinical guidelines, prescription of VTE prevention in patients with major trauma is underused and timing and modality of prophylaxis are rather heterogeneous. When anticoagulation is contraindicated, IVC filters are commonly recommended only in the presence of DVT.
authors.affiliation: Department of Internal Medicine, Piacenza Hospital, Piacenza, Italy. d.imberti@ausl.pc.it
authors.forename: Davide
authors.initials: D
authors.lastname: Imberti
authors.forename: Walter
authors.initials: W
authors.lastname: Ageno
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D019538:Health Care Surveys; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008511:Medicine; D017410:Practice Guidelines as Topic; D011364:Professional Practice; D013038:Specialization; D013689:Telephone; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000188:drug therapy / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight