Venous thromboembolism in trauma: an update for the intensive care unit practitioner.
Venous thromboembolism (VTE) in trauma patients is a capricious problem that continues to plague trauma surgeons and critical care physicians alike. Pharmacologic preventions of VTE with anticoagulants are often contraindicated in the trauma patient because of risk of bleeding diathesis. Mechanical prophylaxis in the form of venous compression boots often cannot be placed because of external fixators, swelling, and so forth. Providing effective VTE prophylaxis, while at the same time providing definitive care for the trauma patient, can be a nightmare. This review will first discuss the incidence and prevalence of VTE, as well as investigate the condition's diagnosis and treatment. Solutions to frequently encountered clinical dilemmas in managing VTE in trauma patients are considered in the form of frequently asked questions. Diagnostic techniques such as magnetic resonance venography, D-dimer, and various computed tomography methods are evaluated. Recent literature on preventive pharmacologic therapies is explored. The authors also consider whether vena cava filters prevent pulmonary embolism in trauma patients.
Rogers
Frederick
F
University of Vermont, Burlington, USA. frederick.rogers@uvm.edu
Rebuck
Jill A
JA
Sing
Ronald F
RF
D006801:Humans; D007362:Intensive Care Units; D008279:Magnetic Resonance Imaging; D018570:Risk Assessment; D013923:Thromboembolism / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D015898:Tomography Scanners, X-Ray Computed; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D014947:Wounds and Injuries / Q000150:complications*