Thromboembolic prophylaxis in head trauma and multiple-trauma patients.
The association between trauma and venous thromboembolism (VTE) is well recognized. VTE consists mainly of deep venous thrombosis (DVT) and pulmonary embolism, a complication that leads to mortality in nearly 50% of cases. Without thromboprophylaxis, the risk of DVT exceeds 50%, but even with routine use of prophylaxis,one third of patients may develop DVT. Despite these findings, appropriate DVT prophylaxis is often not prescribed in trauma patients, mainly because of fear that VTE prophylaxis increases bleeding in injured tissues. Pharmacological VTE prophylaxis is based on the use of low-molecular weight heparins (LMWH). Once-daily or twice-daily LMWH protocols started within 36 h of trauma and continued throughout the hospital stay, or once-daily LMWH followed by a twice-daily protocol are possible options. Mechanical VTE prophylaxis by graduated compression stockings or intermittent pneumatic compression provides suboptimal protection, and its use is recommended only in combination with LMWH prophylaxis unless active bleeding is not controlled. The routine use of VTE prophylaxis in trauma patients is a standard of care. The use of LMWH, started once primary hemostasis has been accomplished, is safe, efficacious and cost-effective in the majority of trauma patients, including TBI patients.
Latronico
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Neuroanesthesia and Neurointensive Care, Department of Anesthesia, Intensive Care and Perioperative Medicine, University of Brescia, Spedali Civili, Brescia, Italy. latronic@med.unibs.it
Berardino
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M
D000925:Anticoagulants / Q000627:therapeutic use; D006259:Craniocerebral Trauma / Q000150:complications*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D009104:Multiple Trauma / Q000150:complications*; D013923:Thromboembolism / Q000209:etiology* / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight