Venous thromboembolism associated with lower limb fractures after trauma: dilemma and management.

BACKGROUND: Trauma patients have the highest risk of developing venous thromboembolism (VTE) among hospitalised patients, with a reported 13-fold greater risk of developing VTE over non-trauma patients. This study examines the incidence of VTE and associated complications in trauma patients with lower limb fractures or injuries.

METHODS: We retrospectively analysed 6,227 trauma patients and classified them according to injury severity score (ISS). The minor trauma group (ISS ≤15) contained 5,637 patients and the major trauma group (ISS >15) contained 590 patients.

RESULTS: In the minor trauma group, VTE incidence was 1.17 %: 0.67 % were diagnosed with deep vein thrombosis (DVT) and 0.5 % with pulmonary embolism (PE). The readmission rate in the following 3-month period was 11 %, of which 2.8 % were subsequently rediagnosed with VTE. The 30-day mortality rate was 2.2 %. Seven patients died from PE following their initial admission and treatment, and another patient died from PE within three months after discharge. In the major trauma group, the VTE incidence was 6.8 %: 5.1 % with diagnosed with DVT and 1.7 % with PE. The readmission rate during the following three-month period was 6.6 %, of which 5 % were readmitted because of VTE and two cases were readmitted because of DVT. The overall 30-day mortality rate was 9.7 %, but no patients were formally diagnosed with a fatal case of PE.

CONCLUSION: This study found that major trauma patients have an approximate six-fold increased risk of developing VTE during admission compared with minor trauma patients (relative risk: 5.79; 95 % confidence interval: 3.94-8.49). Our findings support the use of extended prophylaxis to treat minor trauma patients.