INTRODUCTION: Venous thromboembolism (VTE) is a source of preventable morbidity and mortality in trauma patients. Age is one independent risk factor and predictor for the development of VTE. Geriatric patients are a high thromboembolic and hemorrhagic risk. Currently, there is little guidance between low molecular weight heparin (LMWH) and unfractionated heparin (UFH) for VTE prophylaxis in the geriatric trauma patient. METHODS:Retrospective review at an American College of Surgeons Level I Trauma center from 2016 to 2018. Patients 65 years or older with high risk injury (femur or pelvic fracture, spinal cord injury), admitted to the trauma service were included. Choice of agent was at provider discretion. Patients in renal failure, or receiving no chemoprophylaxis, were excluded. The primary outcomes were deep venous thrombosis (DVT) or pulmonary emboism (PE) and hemorrhagic complication (gastrointestinal bleed, traumatic brain injury expansion, hematoma development). RESULTS:This study evaluated 317 subjects, mean Injury Severity Score was 14. 203 (64%) received LMWH and 114 (36%) received UFH. DVT developed in 7.9% of UFH patients, compared with 4% with LMWH (p ¼ 0.19). PE was present in 4.4% of UFH group, but only 0.5% in the LMWH group (p ¼ 0.01). Combined rate of DVT/PE was significantly lower (p ¼ 0.01) in the LMWH (4.4%) group compared with UFH (12.3%) 11 patients had hemorrhagic complication, there was no association between these events and the use of LMWH or UFH.CONCLUSION: VTE events are more common with UFH compared with LMWH. There was a non-significant decrease in hemorrhagic complication when LMWH was used. LMWH should be considered the chemoprophylatic agent of choice in high-risk geriatric trauma patients.

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Introduction Venous thromboembolism (VTE) is a source of preventable morbidity and mortality in critically ill trauma patients. Age is one independent risk factor. Geriatric patients embody a population at high thromboembolic and hemorrhagic risk. Currently, there is little guidance between low molecular weight heparin (LMWH) and unfractionated heparin (UFH) for anticoagulant prophylaxis in the geriatric trauma patient. Methods A retrospective review was conducted at an ACS verified, Level I Trauma center from 2014 to 2018. All patients 65 years or older, with high-risk injuries and admitted to the trauma service were included. Choice of agent was at provider discretion. Patients in renal failure, or those that received no chemoprophylaxis, were excluded. The primary outcomes were the diagnosis of deep vein thrombosis or pulmonary embolism and bleeding associated complications (gastrointestinal bleed, TBI expansion, hematoma development). Results This study evaluated 375 subjects, 245 (65%) received enoxaparin and 130 (35%) received heparin. DVT developed in 6.9% of UFH patients, compared to 3.3% with LMWH ( P = .1). PE was present in 3.8% of UFH group, but only .4% in the LMWH group ( P = .01). Combined rate of DVT/PE was significantly lower ( P = .006) with LMWH (3.7%) compared to UFH (10.8%). 10 patients had documented bleeding events, and there was no significant association between bleeding and the use of LMWH or UFH. Conclusions VTE events are more common in geriatric patients treated with UFH compared to LMWH. There was no associated increase in bleeding complications when LMWH was utilized. LMWH should be considered the chemoprophylatic agent of choice in high risk geriatric trauma patients.