Epidural catheters are associated with an increased risk of venous thromboembolism in trauma

Vella, Michael A.; Dumas, Ryan P.; Chreiman, Kristen; Wasser, Thomas; Smith, Brian P.; Reilly, Patrick; Seamon, Mark J.; Shiroff, Adam

doi:10.1007/s11239-019-02024-3

Cited by 8 publications

(5 citation statements)

References 33 publications

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“…Enoxaparin dosing is often interrupted after epidural catheter placement, 7 leading to an increased VTE rate. 33 Regional anesthesia guidelines recommend a 12-hour interval between enoxaparin administration and placement or removal of an epidural catheter (24 hours if higher than standard dosing is used), and delaying resumption of the drug by 4-12 hours. 34 35 Efforts to minimize the time without pharmacological protection should be undertaken by meticulously coordinating epidural procedures with drug doses, such that no more than two doses of enoxaparin will be missed.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

Rappold

Sheppard

Carmichael

et al. 2021

Trauma Surg Acute Care Open

104

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Venous thromboembolism (VTE) is a potential sequela of injury, surgery, and critical illness. Patients in the Trauma Intensive Care Unit are at risk for this condition, prompting daily discussions during patient care rounds and routine use of mechanical and/or pharmacologic prophylaxis measures. While VTE rightfully garners much attention in clinical patient care and in the medical literature, optimal strategies for VTE prevention are still evolving. Furthermore, trauma and surgical patients often have real or perceived contraindications to prophylaxis that affect the timing of preventive measures and the consistency with which they can be applied. In this Clinical Consensus Document, the American Association for the Surgery of Trauma Critical Care Committee addresses several practical clinical questions pertaining to specific or unique aspects of VTE prophylaxis in critically ill and injured patients.

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Section: Discussionmentioning

confidence: 99%

Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

Rappold

Sheppard

Carmichael

et al. 2021

Trauma Surg Acute Care Open

104

View full text Add to dashboard Cite

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“…Epidural catheters reduce morbidity and mortality in trauma patients sustaining chest injuries and are often a component of multimodal pain strategies. Patients who require an epidural catheter increasingly have interruptions in pharmacologic prophylaxis 83 such that epidural catheter placement is now associated with an increased VTE rate 84 , 85 whereas previously this was not the case. 86 Regional Anesthesia Guidelines recommend a 12-hour interval between enoxaparin dose and epidural placement/removal followed by a 4-hour to 12-hour interval before resumption.…”

Section: Algorithmmentioning

confidence: 99%

“…Anti-Xa–guided enoxaparin doses are encouraged with limited interruption to reverse the higher VTE rate associated with epidural use. 84 , 85 For unfractionated heparin, a 4 to 6-hour interval is recommended before epidural placement/removal followed by a 1-hour interval before unfractionated heparin is resumed, which allows for uninterrupted dosing.…”

Section: Algorithmmentioning

confidence: 99%

Updated guidelines to reduce venous thromboembolism in trauma patients: A Western Trauma Association critical decisions algorithm

Ley

Brown

Moore³

et al. 2020

J Trauma Acute Care Surg

156

260

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“…Approximately 50% of VTEs are provoked by immobilization, trauma, surgery, or hospitalization in previous 3 months [12][13][14][15], and 20% associated with cancer while 30% unprovoked [16][17][18]. VTE has many risk factors which are constantly multiplied [19][20][21][22][23][24][25]. Currently, Caprini Risk Assessment Scale is widely used in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Predicting the occurrence of venous thromboembolism: construction and verification of risk warning model

Shen

Liu

et al. 2020

BMC Cardiovasc Disord

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Background: The onset of venous thromboembolism is insidious and the prognosis is poor. In this study, we aimed to construct a VTE risk warning model and testified its clinical application value. Methods: Preliminary construction of the VTE risk warning model was carried out according to the independent risk warning indicators of VTE screened by Logistic regression analysis. The truncated value of screening VTE was obtained and the model was evaluated. ROC curve analysis was used to compare the test of Caprini risk assessment scale and VTE risk warning model. The cutoff value of the VTE risk warning model was used to evaluate the test effectiveness of the model for VTE patients with validation data set. Results: The VTE risk warning model is p = e x / (1+ e x), x = − 4.840 + 2.557 • X 10(1) + 1.432 • X 14(1) + 2.977 • X 15(1) + 3.445 • X 18(1) + 1.086 • X 25(1) + 0.249 • X 34 + 0.282 • X 41. ROC curve results show that: AUC (95%CI), cutoff value, sensitivity, specificity, accuracy, Youden index, Caprini risk assessment scale is 0.596 (0.552, 0.638), 5, 26.07, 96.50, 61.3%, 0.226, VTE risk warning model is 0.960 (0.940, 0.976), 0.438, 92.61, 91.83, 92.2%, 0.844, respectively, with statistically significant differences (Z = 14.521, P < 0.0001). The accuracy and Youden index of VTE screening using VTE risk warning model were 81.8 and 62.5%, respectively. Conclusions: VTE risk warning model had high accuracy in predicting VTE occurrence in hospitalized patients. Its test performance was better than Caprini risk assessment scale. It also had high test performance in external population.

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Epidural catheters are associated with an increased risk of venous thromboembolism in trauma

Cited by 8 publications

References 33 publications

Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

Venous thromboembolism prophylaxis in the trauma intensive care unit: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document

Updated guidelines to reduce venous thromboembolism in trauma patients: A Western Trauma Association critical decisions algorithm

Predicting the occurrence of venous thromboembolism: construction and verification of risk warning model

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