Venous thromboembolism after traumatic amputation: an analysis of 366 combat casualties.
BACKGROUND
We sought to determine the incidence, risk factors, and time course for deep vein thrombosis and pulmonary embolism (DVT/PE) after combat-related major limb amputations.


METHODS
Patients with amputation in Iraq or Afghanistan from 2009 through 2011 were eligible. Details of postinjury care, date of diagnosis of DVT/PE, and injury specific data were collected. Military databases and chart reviews were used.


RESULTS
In 366 patients, 103 (28%) had DVT/PE; PE was diagnosed in 59 (16%) and DVT in 59 (16%). Most DVT (69%) and PE (66%) occurred within 10 days. Increasing ventilator days (odds ratio [OR], 1.97; 95% CI, 1.16 to 3.37) and units of blood transfused (OR, 1.72; 95% CI, 1.11 to 2.68) were associated with DVT. Increasing units of fresh-frozen plasma were associated with PE (OR, 1.31; 95% CI, 1.10 to 1.55).


CONCLUSIONS
The incidence of DVT/PE is high after combat-related amputation. Most DVT/PE occur early and prophylaxis is indicated.
Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA. Electronic address: matthew.p.hannon2.mil@mail.mil.
Matthew
M
Hannon
Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
Matthew D
MD
Tadlock
Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA.
Ted
T
Melcer
Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA.
Jay
J
Walker
Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
Jesse
J
Bandle
Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA.
Kameran
K
Nieses
Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, CA, USA.
Michael
M
Galarneau
D055826:Afghan Campaign 2001-; D000673:Amputation, Traumatic / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D013997:Time Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology; D000067398:War-Related Injuries / Q000150:complications / Q000453:epidemiology*
Amputation; Combat injury; Deep vein thrombosis; Pulmonary embolism; Venous thromboembolism