Thromboprophylaxis in pelvic and acetabular trauma surgery

Steele, N.; Dodenhoff, Ron; Ward, Anthony J. I.; Morse, M.H.

doi:10.1302/0301-620x.87b2.14447

Cited by 74 publications

(22 citation statements)

References 22 publications

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“…Observational studies suggest that a delay of more than one to three days in initiating thromboprophylaxis is associated with a significant increase in risk of VTE in patients with major trauma [19],[20]. It is possible that these findings may, at least in part, be generalizable to most hospitalized elderly patients.…”

Section: Limitations Of the Existing Vte Prophylaxis Strategy For Eldmentioning

confidence: 99%

“…Second, many clinicians perceive the risk of bleeding due to pharmacological antithrombotic agents as more important than the risk of VTE, leading to a delay or even omission of VTE prophylaxis in many patients [19],[24]-[26]. This concern is, to some extent, justifiable for hospitalized elderly patients.…”

Section: Limitations Of the Existing Vte Prophylaxis Strategy For Eldmentioning

confidence: 99%

“…For patients who are older than 90 years old, the risk of fatal bleeding is as high as 13%,[27]-[29] especially if they are admitted for severe trauma, hemorrhagic stroke, subdural hematoma, neurosurgery and active gastrointestinal bleeding [30],[31]. Regardless of the causes for a delay in initiating VTE prophylaxis, a delay may turn into omission of VTE prophylaxis altogether during the entire hospital stay of a patient and increases the risk of VTE [19],[20]…”

Section: Limitations Of the Existing Vte Prophylaxis Strategy For Eldmentioning

confidence: 99%

See 2 more Smart Citations

Venous thromboembolism prophylaxis in hospitalized elderly patients: Time to consider a MUST strategy

Ho¹,

Litton²

2011

Journal of Geriatric Cardiology

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Venous thromboembolism (VTE) is the commonest cause of preventable death in hospitalized patients. Elderly patients have higher risk of VTE because of the high prevalence of predisposing co-morbidities and acute illnesses. Clinical diagnosis of VTE in the elderly patient is particularly difficult and, as such, adequate VTE prophylaxis is of pivotal importance in reducing the mortality and morbidities of VTE. Omission of VTE prophylaxis is, however, very common despite continuous education. A simple way to overcome this problem is to implement universal VTE prophylaxis for all hospitalized elderly patients instead of selective prophylaxis for some patients only according to individual's risk of VTE. Although pharmacological VTE prophylaxis is effective for most patients, a high prevalence of renal impairment and drug interactions in the hospitalized elderly patients suggests that a multimodality approach may be more appropriate. Mechanical VTE prophylaxis, including calf and thigh compression devices and/or an inferior vena cava filter, are often underutilized in hospitalized elderly patients who are at high-risk of bleeding and VTE. Because pneumatic compression devices and thigh length stockings are virtually risk free, mechanical VTE prophylaxis may allow early or immediate implementation of VTE prophylaxis for all hospitalized elderly patients, regardless of their bleeding and VTE risk. Although the cost-effectiveness of this Multimodality Universal STat (‘MUST’) VTE prophylaxis approach for hospitalized elderly patients remains uncertain, this strategy appears to offer some advantages over the traditional ‘selective and single-modal’ VTE prophylaxis approach, which often becomes ‘hit or miss’ or not implemented promptly in many hospitalized elderly patients. A large clustered randomized controlled trial is, however, needed to assess whether early, multimodality, universal VTE prophylaxis can improve important clinical outcomes of hospitalized elderly patients.

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Section: Limitations Of the Existing Vte Prophylaxis Strategy For Eldmentioning

confidence: 99%

Section: Limitations Of the Existing Vte Prophylaxis Strategy For Eldmentioning

confidence: 99%

Section: Limitations Of the Existing Vte Prophylaxis Strategy For Eldmentioning

confidence: 99%

See 1 more Smart Citation

Venous thromboembolism prophylaxis in hospitalized elderly patients: Time to consider a MUST strategy

Ho¹,

Litton²

2011

Journal of Geriatric Cardiology

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“…The risk of bleeding with LMWH is small (2%-5%) and acceptable considering the dramatic decrease in proximal thrombi which are at high risk of embolisation 30. However, one must ensure hemodynamic stabilization before initiating chemoprophylaxis, which usually takes 24 to 36 hours from the time of occurrence of injury 303357. Montgomery et al .…”

Section: Discussionmentioning

confidence: 99%

Is routine thromboprophylaxis justified among Indian patients sustaining major orthopedic trauma? A systematic review

Sen

Trıpathy

Singh

2011

IJOO

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Venous thromboembolism (VTE) is one of the most common preventable cause of morbidity and mortality after trauma. Though most of the western countries have their guidelines for thromboprophylaxis in these patients, India still does not have these. The increasing detection of VTE among Indian population, lack of awareness, underestimation of the risk, and fear of bleeding complications after chemical prophylaxis have made deep vein thrombosis (DVT) a serious problem, hence a standard guideline for thromboprophylaxis after trauma is essential. The present review article discusses the incidence of DVT and role of thromboprophylaxis in Indian patients who have sustained major orthopedic trauma. A thorough search of ‘PubMed’ and ‘Google Scholar’ revealed 10 studies regarding venous thromboembolism in Indian patients after major orthopedic trauma surgery (hip or proximal femur fracture and spine injury). Most of these studies have evaluated venous thromboembolism in patients of arthroplasty and trauma. The incidence, risk factors, diagnosis and management of VTE in the subgroup of trauma patients (1049 patients) were separately evaluated after segregating them from the arthroplasty patients. Except two studies, which were based on spinal injury, all other studies recommended screening/ thromboprophylaxis in posttraumatic conditions in the Indian population. Color Doppler was used as common diagnostic or screening tool in most of the studies (eight studies, 722 patients). The incidence of VTE among thromboprophylaxis-receiving group was found to be 8% (10/125), whereas it was much higher (14.49%, 40/276) in patients not receiving any form of prophylaxis. Indian patients have definite risk of venous thromboembolism after major orthopedic trauma (except spinal injury), and thromboprophylaxis either by chemical or mechanical methods seems to be justified in them.

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“…[12][13][14] Observational studies have suggested that a delay of more than 1-3 days in initiating VTE prophylaxis is associated with a threefold increased risk of VTE and possibly also mortality in critically ill and injured patients. [15][16][17][18] Early initiation of VTE prophylaxis using a multimodal approach, including the use of mechanical VTE prophylaxis for many critically ill and injured patients, may be the most effective way to reduce the disease burden of VTE in the critically ill and injured patients. 19 20 Injury is a leading cause of death among young people and was responsible for two-thirds of deaths of young Australians in 2005 despite the injury death rate falling by 50% between 1986 and 2005.…”

Section: Introductionmentioning

confidence: 99%

Detailed assessment of benefits and risks of retrievable inferior vena cava filters on patients with complicated injuries: the da Vinci multicentre randomised controlled trial study protocol

Rao

Honeybul

et al. 2017

BMJ Open

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IntroductionRetrievable inferior vena cava (IVC) filters have been increasingly used in patients with major trauma who have contraindications to anticoagulant prophylaxis as a primary prophylactic measure against venous thromboembolism (VTE). The benefits, risks and cost-effectiveness of such strategy are uncertain.Methods and analysisPatients with major trauma, defined by an estimated Injury Severity Score >15, who have contraindications to anticoagulant VTE prophylaxis within 72 hours of hospitalisation to the study centre will be eligible for this randomised multicentre controlled trial. After obtaining consent from patients, or the persons responsible for the patients, study patients are randomly allocated to either control or IVC filter, within 72 hours of trauma admission, in a 1:1 ratio by permuted blocks stratified by study centre. The primary outcomes are (1) the composite endpoint of (A) pulmonary embolism (PE) as demonstrated by CT pulmonary angiography, high probability ventilation/perfusion scan, transoesophageal echocardiography (by showing clots within pulmonary arterial trunk), pulmonary angiography or postmortem examination during the same hospitalisation or 90-day after trauma whichever is earlier and (B) hospital mortality; and (2) the total cost of treatment including the costs of an IVC filter, total number of CT and ultrasound scans required, length of intensive care unit and hospital stay, procedures and drugs required to treat PE or complications related to the IVC filters. The study started in June 2015 and the final enrolment target is 240 patients. No interim analysis is planned; incidence of fatal PE is used as safety stopping rule for the trial.Ethics and disseminationEthics approval was obtained in all four participating centres in Australia. Results of the main trial and each of the secondary endpoints will be submitted for publication in a peer-reviewed journal.Trial registration numberACTRN12614000963628; Pre-results.

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Thromboprophylaxis in pelvic and acetabular trauma surgery

Cited by 74 publications

References 22 publications

Venous thromboembolism prophylaxis in hospitalized elderly patients: Time to consider a MUST strategy

Venous thromboembolism prophylaxis in hospitalized elderly patients: Time to consider a MUST strategy

Is routine thromboprophylaxis justified among Indian patients sustaining major orthopedic trauma? A systematic review

Detailed assessment of benefits and risks of retrievable inferior vena cava filters on patients with complicated injuries: the da Vinci multicentre randomised controlled trial study protocol

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