title: Thromboprophylaxis following major skeletal trauma: a systematic review.
abstract: OBJECTIVE
  Venous thromboembolic disease following skeletal polytrauma is a major issue for trauma surgeons, but there is no consensus of opinion regarding the optimal form of prophylaxis. The purpose of this paper was to compare the incidence of venous thromboembolic events (VTE) after major skeletal trauma managed with different prophylactic methods and their combinations.
  
  
  METHODS
  A search of AMED, CINAHL, Cochrane Library, EMBASE and MEDLINE databases was performed from their inception to July 2010. A search of unpublished literature databases was undertaken. All randomised controlled trials assessing the incidence of VTE events between two or more forms of thromboprophylaxis for patient following major skeletal trauma were included. Two reviewers independently identified all eligible articles, extracted the data, and critically appraised all included publications using the Critical Appraisal Skills Programme tool.
  
  
  RESULTS
  A total of 11 papers were identified. The findings of this study suggest that low molecular weight heparin (LMWH) may be superior to low dose heparin (LDH), and that LMWH should be used in addition to mechanical prophylaxis measures in patients following major skeletal trauma. There is limited evidence for the use of electrostimulation. There appeared to be no significant difference between the use of LDH compared to calf compression devices. However, the evidence-base was insufficient in both size and methodological quality.
  
  
  CONCLUSIONS
  There is currently insufficient research to be able to inform trauma surgeons as to the optimal method of thromboprophylaxis for patients following major skeletal trauma.
authors.affiliation: School of Allied Health Professions, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK. toby.smith@uea.ac.uk.
authors.forename: T O
authors.initials: TO
authors.lastname: Smith
authors.affiliation: Norfolk and Norwich University Hospital, Norwich, UK.
authors.forename: R
authors.initials: R
authors.lastname: Taylor
authors.affiliation: St George's Hospital, London, UK.
authors.forename: C B
authors.initials: CB
authors.lastname: Hing
keywords: Orthopaedic; Polytrauma; Prophylaxis; Systematic review; Thrombosis; Traumatology
references.citation: Semin Vasc Surg. 1998 Dec;11(4):274-82
references.pmid: 9876034
references.citation: N Engl J Med. 1994 Dec 15;331(24):1601-6
references.pmid: 7969340
references.citation: J Bone Joint Surg Br. 2005 Jul;87(7):965-8
references.pmid: 15972912
references.citation: J Trauma. 1996 Sep;41(3):446-59
references.pmid: 8810961
references.citation: N Engl J Med. 1996 Sep 5;335(10 ):701-7
references.pmid: 8703169
references.citation: Arch Intern Med. 2001 May 28;161(10):1268-79
references.pmid: 11371254
references.citation: J Trauma. 2002 Mar;52(3):453-62
references.pmid: 11901319
references.citation: J Am Coll Surg. 2001 Feb;192(2):161-7
references.pmid: 11220715
references.citation: Am Surg. 2004 Oct;70(10 ):893-6
references.pmid: 15529845
references.citation: Pathophysiol Haemost Thromb. 2005;34(6):249-54
references.pmid: 16772735
references.citation: J Trauma. 1993 Jul;35(1):132-8; discussion 138-9
references.pmid: 8331703
references.citation: Surgery. 2005 May;137(5):493-8
references.pmid: 15855919
references.citation: Health Technol Assess. 2006 May;10 (15):1-168, iii-iv
references.pmid: 16707072
references.citation: J Trauma. 1999 Jul;47(1):25-32
references.pmid: 10421182
references.citation: Br J Surg. 2003 Nov;90(11):1338-44
references.pmid: 14598411
references.citation: QJM. 2006 Jun;99(6):377-88
references.pmid: 16728440
references.citation: Crit Care Med. 2001 Sep;29(9):1659-65
references.pmid: 11546959
references.citation: J Bone Joint Surg Br. 2005 Aug;87(8):1117-22
references.pmid: 16049250
references.citation: Clin Orthop Relat Res. 1996 Aug;(329):68-87
references.pmid: 8769438
references.citation: Ann Intern Med. 2009 Aug 18;151(4):W65-94
references.pmid: 19622512
references.citation: J Trauma. 1992 Jan;32(1):2-11
references.pmid: 1732568
references.citation: J Bone Joint Surg Am. 2006 Feb;88(2):261-6
references.pmid: 16452735
references.citation: J Bone Joint Surg Am. 1995 Nov;77(11):1639-49
references.pmid: 7593073
references.citation: J Bone Joint Surg Am. 1990 Apr;72 (4):495-500
references.pmid: 2182638
references.citation: J Bone Joint Surg Br. 2005 Feb;87(2):209-12
references.pmid: 15736745
references.citation: J Vasc Surg. 2003 Nov;38(5):923-7
references.pmid: 14603195
references.citation: Can J Clin Pharmacol. 2007 Summer;14(2):e215-26
references.pmid: 17652767
references.citation: Surgery. 2001 Jul;130(1):1-12
references.pmid: 11436005
references.citation: J Trauma. 1997 Jan;42(1):100-3
references.pmid: 9003265
references.citation: J Bone Joint Surg Am. 2001 Jul;83-A(7):1047-51
references.pmid: 11451974
references.citation: J Trauma. 2001 Dec;51(6):1098-103
references.pmid: 11740260
references.citation: J Trauma. 2002 Jul;53(1):142-64
references.pmid: 12131409
references.citation: J Trauma. 1994 Sep;37(3):480-7
references.pmid: 8083913
references.citation: J Trauma. 2002 Dec;53(6):1048-52
references.pmid: 12478026
references.citation: Am J Orthop (Belle Mead NJ). 1998 Jan;27(1):53-8
references.pmid: 9452837