Incidence and Nature of Lower-Limb Deep Vein Thrombosis in Patients with Polytrauma on Thromboprophylaxis: A Prospective Cohort Study

Abstract

Purpose: Deep vein thrombosis (DVT) is common among the severely injured and may lead to pulmonary embolism (PE), which can be life threatening. Thromboprophylaxis may reduce the incidence of venous thromboembolism (VTE); it does not guarantee complete protection. This study's primary aim was to determine the incidence and nature of lower-limb DVT in polytrauma patients taking prophylaxis. The secondary objective was to assess the incidence of DVT-related complications, including the development of PE and death. Patients and Methods: This prospective observational study included patients age 18 years or older who presented with polytrauma directly from the scene and were admitted into the trauma unit between March 1, 2020 and August 31, 2020. All patients underwent lowerlimb ultrasound during their hospital course to diagnose DVT. Results: A total of 169 patients underwent extremity Doppler ultrasound to detect DVT. Of these, 69 patients (40.8%) were considered at the highest-risk for VTE development. For VTE prophylaxis, 115 patients (68%) received pharmacologic agents, and 54 patients (32%) had intermittent pneumatic compression on admission. Three patients (1.8%) developed DVT despite prophylaxis. Four patients (2.4%) developed PE during the index presentation and were diagnosed between days 3 and 13 after injury. Early DVT was not detected in any patients with diagnosed PE. Overall, nine patients (5.33%) died, but no in-hospital deaths were related to DVT and/or PE. Conclusion:The incidence of DVT in polytrauma patients remains low in our small series, perhaps because of the mandatory VTE risk assessment for all hospitalized patients and the early initiation of prophylaxis. Using a trauma center registry to measure DVT and PE incidence regularly is recommended to improve trauma care quality.

Risk factors for deep vein thrombosis in patients with pelvic or lower-extremity fractures in the emergency intensive care unit

“…At the same time, hemorrhagic shock, hypoperfusion, and ischemia–reperfusion injury after fluid resuscitation in patients with multiple injuries may make the conditions more serious, leading to multiple injuries as one of the independent risk factors for DVT in patients with pelvic or femur fractures ( 24 ). Despite the preventive measures taken, the incidence of DVT in patients with multiple injuries is still high ( 25 ). Thus, for emergency physicians in EICU to treat patients with multiple injuries accompanying lower extremity fracture, they should raise awareness of thrombosis treatment.…”

Diagnostic value of D-dimer for lower extremity deep venous thrombosis caused by rib fracture: a retrospective study

“…DVT is a serious complication associated with rib fractures, leading to increased recurrence, disability, and mortality rates [ 11 , 12 ]. Clinical symptoms of DVT in rib fracture patients, such as lower limb pain and swelling, are often late or subtle, making early detection challenging and resulting in missed diagnoses and delayed treatment.…”

A Retrospective Study on the Incidence of Pulmonary Embolism in Immobilized Spinal Cord Injury Patients

“…The prevalence of deep vein thrombosis and PE in spinal cord injury was estimated as 14%-100% and 9%-90%, respectively [1]. The incidence of VTE remained low (1.8% for DVT, 2.4% for PE, and 4.2% overall) as reported by Chowdhury et al in polytrauma patients [2].…”