Silent deep vein thrombosis in immobilized multiple trauma patients

Kudsk, Kenneth A.; Fabian, Timothy C.; Baum, Scott; Gold, R. E.; Mangiante, Eugene C.; Voeller, Guy

doi:10.1016/0002-9610(89)90182-7

Cited by 154 publications

(73 citation statements)

References 14 publications

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“…Moreover, the studies are subject to underrecognition of VTE as symptoms may be nonspecific and masked by comorbidity in older patients. [30][31][32][33][34] Also VTE is often silent, [35][36][37] and a previous study found prevalence of 13.5% DVT by ultrasonography screening of institutionalised older individuals.…”

Section: Discuss This Articlementioning

confidence: 95%

Incidence of venous thromboembolism in care homes: a prospective cohort study

et al. 2017

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BackgroundCare home residents have venous thromboembolism (VTE) risk profiles similar to medical inpatients; however, the epidemiology of VTE in care homes is unclear.AimTo determine the incidence of VTE in care homes.Design and settingObservational cohort study of 45 care homes in Birmingham and Oxford, UK.MethodA consecutive sample of care home residents was enrolled and followed up for 12 months. Data were collected via case note reviews of care home and GP records; mortality information was supplemented with Health and Social Care Information Centre (now called NHS Digital) cause of death data. All potential VTE events were adjudicated by an independent committee according to three measures of diagnostic certainty: definite VTE (radiological evidence), probable VTE (high clinical indication but no radiological evidence), or possible VTE (VTE cannot be ruled out). (Study registration number: ISTCTN80889792.)ResultsThere were 1011 participants enrolled, and the mean follow-up period was 312 days (standard deviation 98 days). The incidence rate was 0.71 per 100 person years of observation (95% confidence interval [CI] = 0.26 to 1.54) for definite VTE, 0.83 per 100 person years (95% CI = 0.33 to 1.70) for definite and probable VTE, and 2.48 per 100 person years (95% CI = 1.53 to 3.79) for definite, probable, and possible VTE.ConclusionThe incidence of VTE in care homes in this study (0.71–2.48 per 100 person years) is substantial compared with that in the community (0.117 per 100 person years) and in people aged ≥70 years (0.44 per 100 person years). Further research regarding risk stratification and VTE prophylaxis in this population is needed.

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Section: Discuss This Articlementioning

confidence: 95%

Incidence of venous thromboembolism in care homes: a prospective cohort study

et al. 2017

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“…9 Similar factors were associated with the risk of developing VTE in a study by Kudsk et al in 1989, including spinal, pelvic or lower limb fractures, age (>45 years old), bed rest (>3 days) and previous venous repairs. 10 Inferior vena cava (IVC) filters interrupt the vena cava flow and the migration of a potential thrombus. Trauma patients usually present with multiple injuries involving organs such as the brain or spinal cord which leaves them at risk of fatal bleeding if pharmacological anticoagulation is attempted.…”

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confidence: 94%

“…9,10 In 1994, a comprehensive prospective study of 349 patients by Geerts et al showed various associations between developing VTE and older age, scores on the Abbreviated Injury Scale, lower limb orthopaedic injuries and fractures, spinal cord injuries, blood transfusions within 24 hours of admission and surgical interventions. 9 Similar factors were associated with the risk of developing VTE in a study by Kudsk et al in 1989, including spinal, pelvic or lower limb fractures, age (>45 years old), bed rest (>3 days) and previous venous repairs. 10 Inferior vena cava (IVC) filters interrupt the vena cava flow and the migration of a potential thrombus.…”

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confidence: 99%

Use of Prophylactic Inferior Vena Cava Filters in Trauma

Naiem

Al-Hinai

Al-Sukaiti

et al. 2016

SQUMJ

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“…Venous thromboembolism (VTE) is a common, lifethreatening complication of severe trauma. Without prophylaxis, the reported risk of deep vein thrombosis (DVT) in patients with multiorgan or major trauma varies between 10 and 58% [1][2][3][4] , with the variation in the rate being attributable to the study design and to the diagnos- …”

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confidence: 99%

A Survey of Thromboprophylaxis Management in Patients with Major Trauma

Imberti

Ageno²

2005

Pathophysiol Haemos Thromb

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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.

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Silent deep vein thrombosis in immobilized multiple trauma patients

Cited by 154 publications

References 14 publications

Incidence of venous thromboembolism in care homes: a prospective cohort study

Incidence of venous thromboembolism in care homes: a prospective cohort study

Use of Prophylactic Inferior Vena Cava Filters in Trauma

A Survey of Thromboprophylaxis Management in Patients with Major Trauma

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