Prevention of venous thromboembolism in traumatology


Authors: Petr Kessler 1;  Leopold Pleva 2;  Jindřich Dvořák 3;  Jaromír Gumulec 4
Authors‘ workplace: Odd. hematologie a transfuziologie Nemocnice Pelhřimov ;  Department of hematology and transfusion medicine, Hospital Pelhrimov 1;  Traumatologické centrum FN Ostrava, Ústav medicíny katastrof LF OU 2;  Trauma center, University hospital Ostrava, Department of disaster, Medical faculty University of Ostrava 2;  Traumatologické oddělení Nemocnice Jihlava 3;  Department of traumatology, Hospital Jihlava 3;  Klinika hematoonkologie FN Ostrava 4;  Hemato-oncological clinic, University hospital Ostrava 4
Published in: Úraz chir. 22., 2014, č.2

Overview

Background:
Venous thromboembolism is a major complication in patients with trauma. Based on results of randomized controlled trials, the prophylactic measures are well established in patients with hip fracture. In most other injuries, the high heterogeneity of cases precludes an arrangement of large randomized controlled trials, thus the strength of available evidence is lower, and resulting in skepticism in formulation of evidence based clinical guidelines. The lack of strong recommendations leads often to the omission of thromboprophylaxis even in patients with accumulation of risk factors for thrombosis. A manual which is applicable in clinical practice is thus required.

Aims:
To summarize current knowledge on thromboprophylaxis in trauma patients and form a suitable guide for clinical practice.

Methods:
Relevant publications were searched using Medline database, the level of evidence was evaluated, and 2 level statements were formulated. Statements based on randomized controlled trials, on a meta-analysis, or on a large sophisticated registry were formulated as recommendations, and statements based on lower level evidence or on consensual expert opinion were formulated as suggestions.

Results:
Guidelines on thromboprophylaxis were formulated covering 4 groups of injuries: Hip fracture, lower extremity injury, spinal trauma and major trauma. The role of mechanical and pharmacological measures was defined, considering the risk of thrombotic and bleeding complications in distinct injuries.

Conclusions:
The principles stated in this article should not be applied automatically; an individualized ap-proach should be preferred in patients with accumulation of thrombotic risk factors and in patients with apparently high risk of bleeding.

Key words:
Thromboprophylaxis, trauma, low molecular weight heparin, fondaparinux, guidelines.


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Labels
Surgery Traumatology Trauma surgery
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