Trauma

People that suffer a trauma or are post-injury are at increased risk of developing deep vein thrombosis (DVT) or pulmonary embolism (PE) collectively known as venous thromboembolism (VTE). PE occurs in up to 4% of cases and carries a mortality rate of 20-50%. The incidence of DVT ranges from 5-63% depending on other risk factors, type of prevention used, and methods of detection.

Talk to your doctor about your risk and ways to prevent VTE after trauma or injury.

Trauma Patients at Increased Risk

• Spinal Cord Injuries
• Head Injury
• Lower Limb Injuries
• Trauma Related Venous (vein) Injury, Stasis
• Trauma Related Hypercoagulable State (increased tendency for blood to clot)
• Prolonged Bedrest

Additional Risk Factors

• Older Age
• Obesity
• Smoking
• Past History or Family History of VTE
• Diabetes
• Preexisting Blood Disorders

Prevention

• Low Molecular Weight Heparin if anticoagulation is not contraindicated
• Fondaparinux (anticoagulant)
• Compression Stockings
• Sequential Compression Devices
• Continuous Passive Motion
• IVC filters

Recommendations
All major trauma patients should receive adequate DVT prophylaxis.

IVC filters should be placed in very high risk trauma patients that include those with a Glasgow Coma Scale <8, spinal cord injury, complex pelvic and long bone fractures, and those at increased risk of bleeding who can not be anticoagulated.

References

• Bendinelli, Cina; Balogh, Zsolt. Postinjury Thromboprophylaxis. Curr OPin Crit Care. 2008 Dec; 14(6):673-8.
• Pierce, Charles; et al. Surveillance Bias and Deep Vein Thrombosis in the National Trauma Data Bank: The More We Look, The More We Find. The Journal of Trauma Injury, Infection, and Critical Care. 2008 April; 64(4): 932-937.