title: Four years of an aggressive prophylaxis and screening protocol for venous thromboembolism in a large trauma population.
abstract: BACKGROUND
  This retrospective review of a prospectively collected database was conducted to analyze the efficacy of 4 years of aggressive prophylaxis and screening protocols for venous thromboembolism (VTE) in a large population of trauma patients.
  
  
  METHODS
  Trauma patients at a Level I Trauma Center found to be nonambulatory or otherwise high risk were placed on a protocol of lower-extremity (LE) compression devices and subcutaneous enoxaparin as soon as feasible after admission. Duplex scans of LEs were conducted weekly.
  
  
  RESULTS
  During 4 years, 2,939 patients were admitted to trauma with length of stay >2 days. There was a 3.2% incidence of VTE in the length of stay >2 days population, 2.5% rate of deep venous thrombosis (DVT), and 0.7% pulmonary embolism. All VTE patients had factors known to increase risk of VTE and were included in our prophylaxis and screening protocol. Twenty-one percent of these received pharmacologic prophylaxis within the first 2 days of admission; 62% received enoxaparin at some point before diagnosis of VTE. Duplex scans were conducted in 982 patients. Notably, 86% of LE DVTs were found on routine screening duplex.
  
  
  CONCLUSIONS
  To our knowledge, this is the largest population of trauma patients followed by screening duplexes. All patients with VTEs were identified as high risk, and screening revealed multiple patients with an asymptomatic DVT. We conclude our aggressive prophylaxis regimen lead to low rates of VTE and think screening duplex is a critical component for identifying unsuspected DVT.
authors.affiliation: Department of Surgery of Memorial Health, University Medical Center, Savannah, Georgia, USA.
authors.forename: Raeanna C
authors.initials: RC
authors.lastname: Adams
authors.forename: Miller
authors.initials: M
authors.lastname: Hamrick
authors.forename: Christina
authors.initials: C
authors.lastname: Berenguer
authors.forename: Christopher
authors.initials: C
authors.lastname: Senkowski
authors.forename: M Gage
authors.initials: MG
authors.lastname: Ochsner
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D002985:Clinical Protocols; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015994:Incidence; D048228:Intermittent Pneumatic Compression Devices; D007902:Length of Stay; D035002:Lower Extremity / Q000098:blood supply / Q000000981:diagnostic imaging*; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin