A Survey of Thromboprophylaxis Management in Patients with Major Trauma

Abstract

Background: Venous thromboembolism (VTE) is a common life-threatening complication of major trauma. Although clinical guidelines clearly suggest routine VTE prevention with low-molecular-weight heparin (LMWH) in this specific group of patients, there is still a lack of strong recommendations regarding the timing and the modality of heparin administration and the role of mechanical prophylaxis. We tested the hypothesis that there is significant practice variation in thromboprophylaxis management of patients with major trauma among intensive care unit (ICU) specialists. Methods: Two hundred Italian ICU specialists, representing 200 ICU throughout the country, were contacted by telephone and were asked (1) whether they routinely prescribe pharmacological antithrombotic prophylaxis in patients with major trauma, whether prophylaxis is prescribed to all patients or to selected patients, and the type of prophylaxis and the timing of administration and (2) whether they recommend physical prevention, whether this is prescribed to all patients or to selected patients, and the type of physical prophylaxis. Results: In patients with major trauma, 85% of the interviewed ICU specialists answered that they prescribe pharmacological prophylaxis for VTE. 37.6% of them prescribe prophylaxis only to selected patients based on the level of risk, 87.7% prescribe low-molecular-weight heparin, and 42.4% start prophylaxis immediately after hospitalization. Only 61% of the interviewed specialists prescribe physical prophylaxis; 82.8% of them use elastic stockings, 9.8% intermittent pneumatic compression, and 7.4% other mechanical devices. Physical prophylaxis is prescribed to all patients by 41%, and by 59% only in case of contraindication to pharmacological prevention. Inferior vena cava (IVC) filter insertion is considered by 47% when anticoagulation is contraindicated; 91.4% of them recommend the IVC filter only if deep vein thrombosis (DVT) has been diagnosed. Conclusions: Even when there are clinical guidelines, prescription of VTE prevention in patients with major trauma is underused and timing and modality of prophylaxis are rather heterogeneous. When anticoagulation is contraindicated, IVC filters are commonly recommended only in the presence of DVT.

Coagulation Day 2010: an Austrian survey on the routine of thromboprophylaxis in intensive care

“…Confirming and extending previous surveys, guideline adherence was moderate [10,11]. A combination of pharmacological and mechanical methods for thromboprophylaxis is recommended for critically ill patients at high risk of bleeding and/or DVT [2].…”

“…Furthermore, the results of the survey mirror current practice of thromboprophylaxis in 325 critically ill patients treated in 2010 in Austria, and should not be transferred directly to other settings and countries. Nevertheless, compared to previous surveys [10,11], our results may indicate an improvement in overall adherence to VTE prophylaxis guidelines over the last decade. The response rate was higher than in Italy (17 %) but lower than in France (45 %) and Germany (50 %) [10,11,25].…”

“…Nevertheless, compared to previous surveys [10,11], our results may indicate an improvement in overall adherence to VTE prophylaxis guidelines over the last decade. The response rate was higher than in Italy (17 %) but lower than in France (45 %) and Germany (50 %) [10,11,25]. However, we believe that opinion polls concerning guidelines in wards, departments or hospitals do not reflect reality regarding putting of these recommendations into practice.…”

“…The limited use may be due to educational, economic and logistic issues [14]. Nursing personnel are often concerned about patient discomfort and adverse events of GCS such as blisters and pressure sores [11,14]. However, in the studies included in the above-mentioned Cochrane review no serious adverse events were documented [13].…”

Thrombotic risk assessment questionary helps increase the use of thromboprophylaxis for patients with pelvic and acetabular fractures

“…Thromboembolism prophylaxis has been identified as an algorism of primary importance to improve patient safety in practice 12. However, there is still considerable underutilization of appropriate pharmacologic or mechanical prophylaxis across a broad range of patients with known DVT risk 1314…”