title: Risk factors for venous thromboembolism in critically ill trauma patients who cannot receive chemical prophylaxis.
abstract: BACKGROUND
  Standard venous thromboembolism (VTE) prevention for critically ill trauma patients includes sequential compression devices and chemical prophylaxis. When contraindications to anticoagulation are present, prophylactic inferior vena cava filters (IVCF) may be used to prevent pulmonary emboli (PE) in high-risk patients, but specific indications are lacking. We sought to identify independent predictors of VTE in critically-ill trauma patients who cannot receive chemical prophylaxis in order to identify a subset of patients who may benefit from aggressive screening and/or prophylactic IVCF placement.
  
  
  METHODS
  All trauma patients in the surgical ICU from 2008 to 2009 were prospectively followed. Patients with an ICU length of stay ≥2 days who had contraindications to prophylactic anticoagulation were included. Screening duplex exams were obtained within 48 h of admission and then weekly. CT-angiography for PE was obtained if clinically indicated. Patients were excluded if they did not receive a duplex or if they had a post-injury VTE prior to ICU admission. Data regarding VTE rates (lower extremity [LE] DVT or PE), demographics, past medical history (PMH), injuries, and surgeries were collected. Univariate and multivariable analyses were performed to identify independent predictors of VTE with a p<0.05.
  
  
  RESULTS
  411 trauma patients with a mean age of 48 (SD 22) years and 8 (SD 9) ICU days were included. 72% were male and the mean ISS was 22 (SD 13). 30 (7.3%) patients developed VTE: 28 (6.8%) with LEDVT and 2 (0.5%) with PE. Risk factors for VTE with a p<0.2 on univariate analysis included: PMH of DVT, injury severity score (ISS), extremity fractures (Fx), and a pelvis or LE extremity Fx repair. After logistic regression, only PMH of DVT (OR=22.6) and any extremity Fx (OR=2.4) remained as independent predictors.
  
  
  CONCLUSIONS
  VTE occur in 7% of critically injured trauma patients who cannot receive chemical prophylaxis. Aggressive screening and/or prophylactic IVCF placement may be considered in patients with a PMH of DVT or extremity fractures when anticoagulation is prohibited.
authors: Department of Surgery, Cedars-Sinai Medical Center, USA. darren.malinoski@cshs.org
authors: Darren
authors: D
authors: Malinoski
authors: Tyler
authors: T
authors: Ewing
authors: Madhukar S
authors: MS
authors: Patel
authors: Fariba
authors: F
authors: Jafari
authors: Bryan
authors: B
authors: Sloane
authors: Brian
authors: B
authors: Nguyen
authors: Cristobal
authors: C
authors: Barrios
authors: Allen
authors: A
authors: Kong
authors: Marianne
authors: M
authors: Cinat
authors: Matthew
authors: M
authors: Dolich
authors: Michael
authors: M
authors: Lekawa
authors: David B
authors: DB
authors: Hoyt
mesh_terms: D000792:Angiography; D001778:Blood Coagulation Disorders / Q000503:physiopathology / Q000601:surgery*; D003422:Critical Care / Q000379:methods*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D018570:Risk Assessment; D018084:Ultrasonography, Interventional; D016306:Vena Cava Filters / Q000706:statistics & numerical data; D054556:Venous Thromboembolism / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000503:physiopathology / Q000601:surgery*