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Thromboprophylaxis AND trauma

Philbert Y Van, Martin A Schreiber
PURPOSE OF REVIEW: The traumatically injured patient is at high risk for developing venous thromboembolism. Clinical practice guidelines developed by the American College of Chest Physicians and the Eastern Association for the Surgery of Trauma recognize the importance of initiating thromboprophylaxis, but the guidelines lack specific recommendations regarding the timing and dose of pharmacologic thromboprophylaxis. We review the literature regarding initiation of thromboprophylaxis in different injuries, the use of inferior vena cava filters, laboratory monitoring, dosing regimens, and the use of antiplatelet therapy...
October 5, 2016: Current Opinion in Critical Care
Nan Song, Ai-Xian Tian, Jian-Min Zhang, Hong-Qiang Jiang, Jia-Cheng Zang, Xin-Long Ma
OBJECTIVE: To evaluate the association between F11 rs2289252, rs2036914 polymorphisms and the activity of clotting factor XI in post-trauma patients with fractures receiving routine anticoagulation therapy for deep venous thrombosis (DVT). METHODS: A case-control study involving 110 consecutive post-trauma patients with fractures and DVT in our hospital was conducted from April 2014 to October 2015; these patients comprised a DVT group. Another 40 sex- and age-matched patients with fractures but without DVT served as controls...
August 2016: Orthopaedic Surgery
Ngoh C Liew, Gina V Alemany, Pantep Angchaisuksiri, Soo M Bang, Gordon Choi, Deidre A De Silva, Ji M Hong, Limi Lee, Yong J Li, Ganesan N Rajamoney, John Suviraj, Thiam C Tan, Eric Tse, Li T Teo, Julie Jvisperas, Raymond S Wong, Lai H Lee
The Asian venous thromboembolism (VTE) prophylaxis guidelines was first published in 2012. Since its first edition, the Asian Venous Thrombosis Forum (AVTF) working group have updated the Asian VTE epidemiology and reviewed issues that were not addressed in the previous guidelines. The authors noted that the rising incidence of VTE across Asia may be attributable to aging population, dietary changes, and increasing incidence of obesity and diabetes. The new additions in the guideline include role of thrombophilia in VTE, bleeding risk in Asians, individual risk assessment, updates in the prevention of VTE in medically ill, bariatric surgery, cancer, orthopaedic and trauma patients...
September 8, 2016: International Angiology: a Journal of the International Union of Angiology
Stavros K Kakkos, Joseph A Caprini, George Geroulakos, Andrew N Nicolaides, Gerard Stansby, Daniel J Reddy, Ioannis Ntouvas
BACKGROUND: It is generally assumed by practitioners and guideline authors that combined modalities (methods of treatment) are more effective than single modalities in preventing venous thromboembolism (VTE), defined as deep vein thrombosis (DVT) or pulmonary embolism (PE), or both. This is an update of the review first published in 2008. OBJECTIVES: The aim of this review was to assess the efficacy of combined intermittent pneumatic leg compression (IPC) and pharmacological prophylaxis versus single modalities in preventing venous thromboembolism...
September 7, 2016: Cochrane Database of Systematic Reviews
George A Singer, Gina Riggi, Charles A Karcutskie, Tanaz M Vaghaiwalla, Howard M Lieberman, Enrique Ginzburg, Nicholas Namias, Edward B Lineen
BACKGROUND: Appropriate prophylaxis against venous thromboembolism (VTE) remains undefined. This study evaluated an anti-Xa-guided enoxaparin thromboprophylaxis protocol on the incidence of VTE in high-risk trauma patients based upon Greenfield's Risk Assessment Profile (RAP) score. METHODS: This is a retrospective observational study of patients admitted to a trauma ICU over a 12-month period. Patients were included if they received anti-Xa-guided enoxaparin thromboprophylaxis...
August 3, 2016: Journal of Trauma and Acute Care Surgery
Christopher R Connelly, Philbert Y Van, Kyle D Hart, Scott G Louis, Kelly A Fair, Anfin S Erickson, Elizabeth A Rick, Erika C Simeon, Eileen M Bulger, Saman Arbabi, John B Holcomb, Laura J Moore, Martin A Schreiber
Importance: Prophylactic enoxaparin is used to prevent venous thromboembolism (VTE) in surgical and trauma patients. However, VTE remains an important source of morbidity and mortality, potentially exacerbated by antithrombin III or anti-Factor Xa deficiencies and missed enoxaparin doses. Recent data suggest that a difference in reaction time (time to initial fibrin formation) greater than 1 minute between heparinase and standard thrombelastogram (TEG) is associated with a decreased risk of VTE...
August 3, 2016: JAMA Surgery
Ara Ko, Megan Y Harada, Galinos Barmparas, Kevin Chung, Russell Mason, Dorothy A Yim, Navpreet Dhillon, Daniel R Margulies, Bruce L Gewertz, Eric J Ley
Importance: Trauma patients are at high risk for developing venous thromboembolism (VTE). The VTE rate when enoxaparin sodium is dosed by anti-factor Xa (anti-Xa) trough level is not well described. Objective: To determine whether targeting a prophylactic anti-Xa trough level by adjusting the enoxaparin dose would reduce the VTE rate in trauma patients. Design, Setting, and Participants: Single-institution, historic vs prospective cohort comparison study at an urban, academic, level I trauma center...
July 6, 2016: JAMA Surgery
Titilope Ishola, Susan E Kirk, Danielle Guffey, Katherine Voigt, Mona D Shah, Lakshmi Srivaths
INTRODUCTION: In adolescent thromboembolism (TE), multiple risk factors (RFs) and co-morbidities (CMs) are reported, though overall prevalence has not been evaluated. We hypothesized that the spectrum of RFs/CMs in adolescent TE differs from children overall and sought to review Texas Children's Hospital's experience. PATIENTS/METHODS: Medical records of adolescents aged 12-21years, diagnosed with arterial or venous TE (AT/DVT) from 2004 to 2014, were retrospectively reviewed and analyzed with IRB approval...
May 2016: Thrombosis Research
Syed Haque, Amit Bishnoi, Hamidreza Khairandish, Dipen Menon
UNLABELLED: Lower-limb immobilization has been implicated as an etiological factor for venous thromboembolic events (VTEs). However, there is no patient-centered scoring system available for risk assessment in ambulatory trauma patients with temporary lower-limb immobilization. A patient questionnaire scoring system has been developed for ambulatory patients with foot and ankle fracture being managed nonoperatively as outpatients by temporary lower-limb immobilization. Patients are classed as either high or low risk for developing a VTE and offered low-molecular-weight heparin (LMWH) accordingly...
October 2016: Foot & Ankle Specialist
Guowei Li, Lehana Thabane, Deborah J Cook, Renato D Lopes, John C Marshall, Gordon Guyatt, Anne Holbrook, Noori Akhtar-Danesh, Robert A Fowler, Neill K J Adhikari, Rob Taylor, Yaseen M Arabi, Dean Chittock, Peter Dodek, Andreas P Freitag, Stephen D Walter, Diane Heels-Ansdell, Mitchell A H Levine
BACKGROUND: Previous studies have suggested that prediction models for mortality should be adjusted for additional risk factors beyond the Acute Physiology and Chronic Health Evaluation (APACHE) score. Our objective was to identify risk factors independent of APACHE II score and construct a prediction model to improve the predictive accuracy for hospital and intensive care unit (ICU) mortality. METHODS: We used data from a multicenter randomized controlled trial (PROTECT, Prophylaxis for Thromboembolism in Critical Care Trial) to build a new prediction model for hospital and ICU mortality...
December 2016: Annals of Intensive Care
Paul S Whiting, A Alex Jahangir
Orthopedic trauma results in systemic physiologic changes that predispose patients to venous thromboembolism (VTE). In the absence of prophylaxis, VTE incidence may be as high as 60%. Mechanical and pharmacologic thromboprophylaxis are effective in decreasing rates of VTE. Combined mechanical and pharmacologic thromboprophylaxis is more efficacious for decreasing VTE incidence than either regimen independently. If pharmacologic thromboprophylaxis is contraindicated, mechanical prophylaxis should be used. Patients with isolated lower extremity fractures who are ambulatory, or those with isolated upper extremity trauma, do not require pharmacologic prophylaxis in the absence of other VTE risk factors...
April 2016: Orthopedic Clinics of North America
S Haque, M B Davies
BACKGROUND: Lower-limb immobilization has been implicated as an etiologic factor for a venous thromboembolism (VTE). Most of the current literature encourages the use of thromboprophylaxis with injectable low-molecular-weight heparin (LMWH) in trauma patients. Injectable anticoagulants have inherent problems of producing pain and bruising. They are also difficult to administer, leading to low compliance. Oral anticoagulants are therefore gaining popularity for use as thromboprophylactic agents in hip and knee arthroplasty patients...
December 2015: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Casey J Allen, Clark R Murray, Jonathan P Meizoso, Juliet J Ray, Holly L Neville, Carl I Schulman, Nicholas Namias, Juan E Sola, Kenneth G Proctor
BACKGROUND/PURPOSE: The purposes of this study were to identify independent predictors of venous thromboembolism (VTE), to evaluate the relative impact of adult VTE risk factors, and to identify a pediatric population at high-risk for VTE after trauma. METHODS: 1934 consecutive pediatric admissions (≤ 17 years) from 01/2000 to 12/2012 at a level 1 trauma center were reviewed. Logistic regression was used to identify predictors of VTE. RESULTS: Twenty-two patients (1...
January 2016: Journal of Pediatric Surgery
R A van Adrichem, J P van Oosten, S C Cannegieter, I B Schipper, R G H H Nelissen
BACKGROUND: The effect of prophylaxis on the prevention of symptomatic venous thrombosis in patients with lower leg cast immobilisation or after knee arthroscopy is not clear. Our aim was to assess the current practice of thrombosis prophylaxis in Dutch hospitals and to determine considerations for prescribing prophylaxis. METHODS: Electronic questionnaires regarding thrombosis prophylaxis in patients with lower leg cast immobilisation or after knee arthroscopy were sent to all orthopaedic (90) and trauma surgery departments (89) and orthopaedic clinics (16) in the Netherlands...
January 2015: Netherlands Journal of Medicine
Casey J Allen, Clark R Murray, Jonathan P Meizoso, Juliet J Ray, Laura F Teisch, Xiomara D Ruiz, Mena M Hanna, Gerardo A Guarch, Ronald J Manning, Alan S Livingstone, Enrique Ginzburg, Carl I Schulman, Nicholas Namias, Kenneth G Proctor
We hypothesize there are coagulation profile changes associated both with initiation of thromboporphylaxis (TPX) and with change in platelet levels in trauma patients at high-risk for venous thromboembolism (VTE). A total of 1203 trauma intensive care unit patients were screened with a VTE risk assessment profile. In all, 302 high-risk patients (risk assessment profile score ≥ 10) were consented for weekly thromboelastography. TPX was initiated between initial and follow-up thromboelastography. Seventy-four patients were analyzed...
July 2015: American Surgeon
Jitendra Mangwani, Nomaan Sheikh, Matthew Cichero, David Williamson
Venous thromboembolism (VTE) is a well documented complication following lower limb trauma and surgery. The incidence of VTE in hip and knee surgery has been well studied, whereas the incidence in foot and ankle surgery is less clear. There is debate as to which cases require prophylaxis and what is the most effective means by which this is achieved. We performed a systematic review of the published English literature on VTE prophylaxis in foot and ankle surgery using MEDLINE, EMBASE, CINHAL, Cochrane Library, without date restrictions up to December 2012...
September 2015: Foot
G J Heyes, A Tucker, A L R Michael, R G H Wallace
PURPOSE: The routine use of thromboprophylaxis during cast immobilisation for lower leg trauma is controversial. The concern involves the perceived increased risk of deep vein thrombosis (DVT) and its sequelae following leg immobilisation. However, immobilisation is used for a spectrum of trauma and for varying duration. This heterogenicity in management is reflected in the current evidence and coupled with the risks of thromboprophylaxis; no clear consensus has been made. METHODS: In this retrospective study, we report the incidence of DVT and pulmonary embolism (PE) observed following cast immobilisation and early functional management of patients with Tendo Achilles rupture...
June 2015: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
S Vollans, A Chaturvedi, K Sivasankaran, T Madhu, Y Hadland, V Allgar, H K Sharma
INTRODUCTION: Venous thromboembolism (VTE) is a significant cause of morbidity and mortality following tibial fractures. The risk is as high as 77% without prophylaxis and around 10% with prophylaxis. Within the current literature there are no figures reported specifically for those individuals treated with circular frames. Our aim was to evaluate the VTE incidence within a single surgeon series and to evaluate potential risk factors. METHODS: We retrospectively reviewed our consecutive single surgeon series of 177 patients admitted to a major trauma unit with tibial fractures...
2015: Injury
Casey J Allen, Albert Hsu, Clark R Murray, Jonathan P Meizoso, Juliet J Ray, Carl I Schulman, Alan S Livingstone, Edward B Lineen, Enrique Ginzburg, Nicholas Namias, Kenneth G Proctor
BACKGROUND: There are many benefits of repair over ligation of major venous injuries (MVIs) following penetrating trauma, but the risk of pulmonary embolism (PE) is not well defined. We hypothesized that rates of PE are comparable between repair and ligation of MVI. METHODS: All penetrating trauma patients with MVI requiring an operation from 2003 to 2012 (n = 158) were retrospectively reviewed. Propensity scores were based on a logistic regression model using patient and injury characteristics...
March 2015: Journal of Trauma and Acute Care Surgery
Ola E Dahl, Job Harenberg, Fredrik Wexels, Klaus T Preissner
A variety of harmful effects can be triggered by trauma and major orthopedic surgery. One of the key players involved in this process is thrombin. The clinical consequence of this process has, for several decades, been considered to be formation of deep vein thrombosis and pulmonary embolism. Controlling thrombin generation and activation has therefore been the goal of thromboprophylaxis regimens administered to patients suffering from trauma or undergoing major surgery. Protecting patients from venous thromboembolism has, for many years, been the main goal of preventive strategies...
March 2015: Seminars in Thrombosis and Hemostasis
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