Postinjury thromboprophylaxis.
OBJECTIVE
In trauma patients, pulmonary embolism occurs in up to 4% of cases and carries a mortality of 20-50%. The incidence of deep vein thrombosis (DVT) varies from 5 to 63% depending on patients' risk factors, modality of prophylaxis, and methods of detection. For these reasons, trauma patients require adequate DVT prophylaxis.


RESULTS
Spinal fracture or cord injury patients are at particular risk. Increasing injury severity, head injury, older age, lower limb injuries, and obesity are other risk factors. The current standard of care for DVT prophylaxis is enoxaparin (a low molecular weight heparin) as long as anticoagulation is not contraindicated. Unfractionated heparin alone does not provide sufficient protection against DVT. Selective factor Xa inhibitors such as fondaparinux are showing promising results. Other strategies for pulmonary embolism prevention include: graduated compression stockings, sequential compression devices, continuous passive motion, and prophylactic inferior vena cava filter. There is lack of consensus regarding the optimal DVT prophylaxis in trauma patients and few level I recommendations exist.


CONCLUSIONS
Best practice in thromboprophylaxis for trauma patients will remain on the basis of recommendations until definitive risk-benefit ratios are determined to justify the use of various mechanical and pharmacological measures, in combination or alone.
Bendinelli
Cino
C
Department of Traumatology, Division of Surgery, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia. Cino.Bendinelli@hnehealth.nsw.gov.au
Balogh
Zsolt
Z
D000925:Anticoagulants / Q000627:therapeutic use*; D016638:Critical Illness; D017984:Enoxaparin / Q000627:therapeutic use; D065427:Factor Xa Inhibitors; D000077425:Fondaparinux; D006801:Humans; D015994:Incidence; D011134:Polysaccharides / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D013997:Time Factors; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications*
D000925:Anticoagulants; D017984:Enoxaparin; D065427:Factor Xa Inhibitors; D011134:Polysaccharides; D000077425:Fondaparinux